Stepwise Devascularization and Resection of the Placenta with Adherent Uterine Wall. A New Effective Applicable Technique to Preserve the Uterus in Morbidly Adherent Placenta: Case Series
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- Category: Vol. 89, June 2021
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Stepwise Devascularization and Resection of the Placenta with Adherent Uterine Wall. A New Effective Applicable Technique to Preserve the Uterus in Morbidly Adherent Placenta: Case Series, AHMED A. KHALIFA, MAGDY M. AMEEN, MOHAMMED S. ISMAIEL, YOUSEF S. YOUSEF, MOSTAFA MAHMOUD, OMAR M. FAHMY and MARIAM M. ELSHAMANDY
Abstract
Background: Morbidly adherent placenta is considered one of the most life-threatening obstetric complications and may cause severe intra operative bleeding requiring massive blood transfusion. The challenge is how to preserve the uterus with less complications? Aim of Study: This study aimed to present an alternative applicable surgical technique to save the uterus in cases with MAP by application of stepwise devascularization and resection of the placenta with adherent uterine wall. Material and Methods: It is a retrospective study in which 75 patients with morbidly adherent placenta, who delivered by cesarean section, were selected. Bilateral uterine artery ligation was done after downward dissection of the bladder, followed by upper uterine segment incision, downward step-wise clamping and resection of the whole lower uterine segment with adherent placenta till the cervix by vertical and transverse clamps. Finally reconstruction of the uterus was done. The amount of blood loss, operative time, post-operative hospital stay and operative complications were analyzed. Results: In all cases the placenta was adherent to the lower uterine segment and involving the posterior wall of the bladder in four cases. In all cases the mean estimated blood loss was 1156.3±403.2mL, the mean operative time was 76.3 ±24.5min, and the mean post-operative hospital stay was 3.8± 1.6 days. The four cases, in which the placenta was invading the bladder wall, underwent bladder repair due to bladder injury during dissection. In all cases, the uterus had been preserved. No other intra operative complications were reported. Conclusion: Stepwise devascularization and resection of the placenta with adherent uterine wall is an effective and applicable technique to preserve the uterus in patients with morbidly adherent placenta with excellent operative results, less blood loss, blood transfusion was needed in limited cases.