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#204 Placenta accreta spectrum: a call for action to gynecologic oncologists
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  1. Mine Daggez1,
  2. Polat Dursun2 and
  3. Tufan Arslanca3
  1. 1Tekirdag City Hospital, Tekirdag, Türkiye
  2. 2Private Clinic, Ankara, Türkiye
  3. 3Ankara Bilkent City Hospital, Ankara, Türkiye

Abstract

Introduction/Background Postpartum hemorrhage (PPH) is an important cause of maternal morbidity and mortality, and is associated with 25% of peripartum maternal deaths worldwide [1]. Placenta accreta spectrum (PAS) is a severe risk factor for PPH[2]. PAS have become one of the most important iatrogenic public health problems today. The incidence changes between 0.3% and 6.7% [3]. The risk may be 11% with one prior cesarean section, 40% with two and 60% with three or more[4]. Maternal morbidity ranges from 24% to 67% [5].

Many institutions worldwide rely on gynecologic oncologists in the surgical management of PAS [6]. 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:

  • Midline incision

  • Transfundal extraction of the fetus

  • Identification of retroperitoneal landmarks

  • Bulldog clamp attachment to the internal iliac artery

  • Bladder dissection

  • 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).

Abstract #204 Table 1

Operative findings

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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