Case Report of Placenta Accreta: Successful Management with Conservative Surgery
Abstract
The incidence of placenta accreta spectrum (PAS) disorders has increased over the last decades due to increase in cesarean deliveries, resulting in increase in cesarean hysterectomies , maternal mortality and morbidity but since last few years there has been a gradual shift towards the idea of conservative management. Conservative management of PAS is known to reduce major obstetric hemorrhage and salvage hysterectomy. We present a case of placenta accreta diagnosed by ultrasound where management of post-partum hemorrhage was accomplished by conservative surgery. The concise steps taken in management of placenta accreta before and during cesarean section were: Availability of 4 donors with cross match; Stark cesarean section; atraumatic clamps around uterine arteries; ureterotonic drugs; external (B-Lynch suture); and application of diathermy where required. This experience indicates that few selected cases of PAS could be managed conservatively who are at risk of intra-partum hemorrhage and post-partum hemorrhage.
Downloads
References
2. M. Arduini, G. Epicoco, G. Clerici, E. Bottaccioli, S. Arena, and G. Affronti, “B-Lynch suture, intrauterine balloon, and endouterine hemostatic suture for the management of postpartum hemorrhage due to placenta previa accreta,” International Journal of Gynecology and Obstetrics, vol. 108, no. 3, pp. 191–193, 2010.
3. C. B-Lynch, A. Coker, A. H. Lawal, J. Abu, and M. J. Cowen, “The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported,” British Journal of Obstetrics and Gynaecology, vol. 104, no. 3, pp. 372–375, 1997.
4. J. M. Palacios-Jaraquemada. One-Step Conservative Surgery for Abnormal Invasive Placenta (Placenta Accreta–Increta–Percreta) vol .2, no.31; pp. 177:264–71
5. K. M. Flood, S. Said, M. Geary, M. Robson, C. Fitzpatrick, and F. D. Malone, “Changing trends in peripartum hysterectomy over the last 4 decades,” American Journal of Obstetrics and Gynecology, vol. 200, no. 6, pp. 632.e1–632.e6, 2009.
6. S. Wu, M. Kocherginsky, and J. U. Hibbard, “Abnormal placentation: twenty-year analysis,” American Journal of Obstetrics and Gynecology, vol. 192, no. 5, pp. 1458–1461, 2005.
7. W. C. Baughman, J. E. Corteville, and R. R. Shah, “Placenta accreta: spectrum of US and MR imaging findings,” Radiographics, vol. 28, no. 7, pp. 1905–1916, 2008.
8. B. K. Dwyer, V. Belogolovkin, L. Tran et al., “Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging?” Journal of Ultrasound in Medicine, vol. 27, no. 9, pp. 1275–1281, 2008.
9. H. A. Mousa and Z. Alfrevic, “Major postpartum hemorrhage: survey of maternity units in the United Kingdom,” Acta Obstetricia et Gynecologica Scandinavica, vol. 81, no. 8, pp. 727–730, 2002.
10. R. G. Hayman, S. Arulkumaran, and P. J. Steer, “Uterine compression sutures: surgical management of postpartum hemorrhage,” Obstetrics and Gynecology, vol. 99, no. 3, pp. 502–506, 2002.
11. J. H. Cho, H. S. Jun, and C. N. Lee, “Hemostatic suturing technique for uterine bleeding during cesarean delivery,” Obstetrics and Gynecology, vol. 96, no. 1, pp. 129–131, 2000.
12. Y. Y. Cheng, J. I. Hwang, S. W. Hung et al., “Angiographic embolization for emergent and prophylactic management of obstetric hemorrhage: a four year experience,” Journal of the Chinese Medical Association, vol. 66, no. 12, pp. 727–734, 2003.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright © Author(s) retain the copyright of this article.
