Introduction/Background Postpartum hemorrhage (PPH) is an important cause of maternal morbidity and mortality, and is associated with 25% of peripartum maternal deaths worldwide . Placenta accreta spectrum (PAS) is a severe risk factor for PPH. PAS have become one of the most important iatrogenic public health problems today. The incidence changes between 0.3% and 6.7% . The risk may be 11% with one prior cesarean section, 40% with two and 60% with three or more. Maternal morbidity ranges from 24% to 67% .
Many institutions worldwide rely on gynecologic oncologists in the surgical management of PAS . Gynecologic oncology associations have not yet taken an active step in determining the standardized surgical steps, developing guidelines and spreading it. Here we propose a useful technique and present results on 61 patients diagnosed with PAS.
Methodology 61 patients with preoperative radiologic and intraoperative diagnosis of PAS was included. Defined surgical technique by the same multidisciplinary team lead by gynecologic oncologists was performed in each case. The steps of the technique were as follows:
Transfundal extraction of the fetus
Identification of retroperitoneal landmarks
Bulldog clamp attachment to the internal iliac artery
Hysterectomy and cuff closure
Complication management (repair of the bladder or other ureteral injury)
Pre- and postsurgical parameters, estimated blood loss (EBL) (mL), blood transfusion requirement >5 units of packed red cells, and visceral injuries were recorded.
Results Intraoperative blood replacement was not performed in 83.6%. Postoperative blood transfusion was performed in 8.2% of the patients. Ureteral injury occurred in 9.8% and bladder injury occurred in 11.5% (table 1).
Conclusion Our society should define and spread new techniques and guidelines for this life-threatening condition in which we are the ones commonly relied on in many settings worldwide.
Disclosures Gynecologic oncologists should be proactively involved in the management of PAS.
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