A Novel Approach in Management of Placenta Accreta Spectrum Disorders: A Single-Center Surgical Experience From Vietnam
Journal – Journal of Clinical Gynecology & Obstetrics
Article type – Journal research article – Clinical research
Publication date – Oct – 2022
Authors – Xuan Trang Thi Pham, Anh Dinh Bao Vuong, Lan Ngoc Vuong, Phuc Nhon Nguyen
Keywords – Blood transfusion, Cesarean delivery, Conservative surgery, Maternal-fetal medicine, Obstetric hemorrhage, Placenta accreta spectrum
Open access – Yes
Speciality – Obstetrics and Gynaecology
World region South-eastern Asia
Language – English
Submitted to the One Surgery Index on October 30, 2022 at 7:04 am
Background: Placenta accreta spectrum disorder (PASD) is the leading cause which results in highly maternal mortality during pregnancy. Although hysterectomy has been the gold standard for PASD, recent data, together with our experience, suggest that conservative management might be better; and thus, we here attempted to determine this.
Methods: A retrospective observational study enrolled 65 patients at the Tu Du Hospital in Vietnam between January 2017 and December 2018. This study included all pregnant women above 28 weeks of gestational age, who had undergone cesarean delivery due to PASD diagnosed preoperatively by ultrasound or upon laparotomy. Additionally, all patients who desired uterine preservation underwent uterine conservative surgery, avoiding hysterectomy.
Results: Overall, the rate of successful preservation was 93.8%. Other main parameters evaluated included average operative blood loss of 987 mL, mean blood transfusion of 831 ± 672 mL; mean operative time of 135 ± 31 min, and average postoperative time of 5.79 days. Postoperative complications happened in six out of 65 cases due to intraoperative bleeding and postoperative infection, requiring peripartum hysterectomy in four patients.
Conclusions: Uterine conservative surgery was associated with less operative blood loss and blood transfusion amount. Its success rate of preservative method was approximately 94% in our study. Thus, this method can be acceptable in PASD management. Further studies might be necessary to evaluate the long-term effects of this method in PASD management
OSI Number – 21803