Jsmc-10384

THE ROLE OF EARLY CLAMPING OF UTERINE ARTERY AND DELAYED PLACENTAL SEPARATION IN REDUCING CONSEQUENCES OF PLACENTA ACCRETA SPECTRUM (PAS) DISORDER

Tahir Abdullah Hussein a, Naz Azad Abdullah a, Maryam Bakr Mahmood a, Jwan Maasoum Hawrami b, and Nigar Mohammed Salih Barzinj b

a College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

b Director of Health, Ministry of Health, Kurdistan Region, Iraq.

Submitted: 27/5/2022; Accepted: 21/10/2022; Published: 21/12/2022

DOI Link: https://doi.org/10.17656/jsmc.10384 

ABSTRACT 

Background 

Abnormal invasive placentation leads to massive intraoperative bleeding and maternal morbidity or death. The current study aimed to evaluate the role of systemic pelvic devascularization technique in reducing cesarean hysterectomy in pregnancies involved in PAS and its complication.

Objectives 

To deterime role of early claming of uterine artery and delayed placental separation in reducing the consequences of placenta accreta spectrum disorders 

Patients and Methods

Case series research was done in a Maternity Teaching Hospital as a single center study on twenty high-risk pregnant ladies at (32 to37 weeks) gestation diagnosed with placenta accrete through ultrasonography from the first of January 2021 to the first of November 2021.

All patients were managed through the technique of delayed delivery of the placenta and early clamping uterine artery at the level of the internal os of the cervix using two vascular clamps followed by immediate ligation of the anterior branch of the internal iliac artery (IIA) in the retroperitoneal space within 1-2 minutes which shows a significant reduction in blood loss at placental bed following placental delivery, neither of cases ended by cesarean hysterectomy, written consent has been taken from the enrolled patients. A college has approved the study of the medicine Ethical Committee /the University of Sulaimani. Data from the current study has been analyzed using “IBM SPSS statistics version 25”.

Results

Among the patients who participated in the present study, the mean±SD of age was 37.1 ± 4.5 years range (30-48) years old, and the mean±SD gestational age was 36 ± 1.5 range (32 to 38) weeks, their mean ±SD of BMI (body mass index) was 28 ± 2.2 (range, 24 to 32). The mean±SD cesarean count was 2.8 ± 1.3 (range, 0-5). The mean±SD of patients’ gravida and parity were 4.2 ± 1.6 (range,1-7) and 2.8 ± 1.4 (range,0-5), respectively.The mean±SD operation time varies 93 ± 25.6 range (60 to 120 minutes ); neither of the cases ended by hysterectomy, hemoglobin levels were also taken as part of the investigation, and its level preoperatively means ± SD 11.4 ± 1.1( range, 9.9 to 13.9) and post-operatively mean ± SD level was 9.6 ± 1.2 (range, 7.2 to 11.1), significantly less blood loss seen intraoperatively and only 75% of them require blood transfusion and only one-day hospital stay after the operation, no one requires the second laparotomy. Therefore, there was no significant association between them; thence, the mentioned procedure is clinically beneficial. 

Conclusion

This method did not need to cesarean hysterectomy, so it causes less blood loss and morbidity.

KEYWORDS

Placenta accrete, blood transfusion, cesarean hysterectomy.

References 

1. American College of Obstetricians and GynecologistsPublished by Elsevier ;2018.219(6):B2-B16.

2. Benirschke K, Burton GJ, Baergen RN. Pathology of the human placenta. 6th ed. Berlin: Springer Verlag; 2012. 513–32 

3. Burton GJ, Woods AW, Jauniaux E, Kingdom JCP. Rheological and Physiological Consequences of Conversion of the Maternal Spiral Arteries for Uteroplacental Blood Flow during Human Pregnancy. Placenta. 2009;30(6):473–482. doi:10.1016/j.placenta.2009.02.009

4. Gary C, Kenneth J, Steven L, John C, Catherine Y. Prior cesarean delivery. Williams Obstetrics. 23rd ed. New York: McGraw-Hill; 2010. P. 574-5.  

5.  Marshall NE , Fu R , Guise JM . Impact of multiple cesarean deliveries on maternal morbidity: a systematic review . Am J Obstet Gynecol 2011 ; 205 : 262.p .1 – 8

6. BJauniaux E , Collins S , Burton GJ . Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging . Am J Obstet Gynecol 2018 ; 218 : 75 – 87 .

7. eEller AG , Bennett MA , Sharshiner M , Masheter C , Soisson AP , Dodson M , et al . Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care . Obstet Gynecol 2011 ; 117 : 331 – 7 .

8. Shamshirsaz AA , Fox KA , Salmanian B , Diaz-Arrastia CR , Lee W , Baker BW , et al . Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach . Am J Obstet Gynecol 2015 ; 212 : 218.e1 – 9 

9. Berkley EM , Abuhamad AZ . Prenatal diagnosis of placenta accreta: is sonography all we need ? J Ultrasound Med ; 2013 . 32 (8).p. 1345 – 50 .

10. D’Antonio F , Iacovella C , Bhide A . Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis . Ultrasound Obstet Gynecol .2013 ; 42 (5): 509-17. 

11. GTG green top guideline . 2018 .available from : www.rcog.org.uk

12. Silver RM , Barbour KD . Placenta accreta spectrum: accreta, increta, and percreta . Obstet Gynecol Clin North Am. 2015 ; 42 : p 381 – 402 . 

13. Belfort MA . Placenta accreta. Publications Committee, Society for Maternal-Fetal Medicine . Am J Obstet Gynecol. 2010 ; 203 : p 430 – 9 .

14. Angstmann T , Gard G , Harrington T , Ward E , Thomson A , Giles W . Surgical management of placenta accreta: a cohort series and suggested approach . Am J Obstet Gynecol . 2010 ; 202 : 38. e1 – 9 .

15. Gyamfi-Bannerman C . Society for Maternal-Fetal Medicine (SMFM) Consult Series #44: management of bleeding in the late preterm period. Society for Maternal-Fetal Medicine (SMFM) . Am J Obstet Gynecol .2018 ; 218 : B2 – 8 .

16. Shamshirsaz AA , Fox KA , Erfani H , Clark SL , Salmanian B , Baker BW , et al . Multidisciplinary team learning in the management of the morbidly adherent placenta: outcome improvements over time . Am J Obstet Gynecol 2017 ; 216 : p.612.

17. Use of prophylactic antibiotics in labor and delivery. Practice Bulletin No. 120. American College of Obstetricians and Gynecologists . Obstet Gynecol 2011 ; 117 :p. 1472 –1483

18. Fox KA , Shamshirsaz AA , Carusi D , Secord AA , Lee P , Turan OM , et al . Conservative management of morbidly adherent placenta: expert review . Am J Obstet Gynecol 2015 ; 213 : 755 – 60 .

19. Perez-Delboy A , Wright JD . Surgical management of placenta accreta: to leave or remove the placenta? BJOG .2014 ; 121 : 163 – 9 .

20. Zlatnik MG, Cheng YW, Norton ME, Thiet M-P, Caughey AB.Placenta previa and the risk of preterm delivery. J Matern Fetal Neonatal Med. 2007;20:719–23.

21.  Morrison JJ, Rennie JM, Milton PJ. Neonatal respirator morbidity and mode of delivery at term: influence of timing ofelective caesarean section. Br J Obstet Gynaecol 1995 Oct;102(10):843-4

22. Savcı, G. , Ozdemir, A. , Karlı, P. , Kocak, İ. , Katırcı, Y. and Önal M, etal . A Different Method in the Treatment of Placenta Previa: A Comparison of Lower Uterine Segment Transverse Suture Technique and Bakri Balloon Application. Open Journal of Obstetrics and Gynecology;2019. Vol.9(3) p 334-342.

23.  Rossi AC, Lee RH, Chmait RH. Emergency postpartumhysterectomy for uncontrolled postpartumbleeding: a systematic review. Obstet Gynecol. 2010;115(03):637-644. Doi: 10.1097/AOG.0b013e3181cfc007.available from: https://doi.org/10.1097/AOG.0b013e3181cfc007

24.  Michelet D, Ricbourg A, Gosme C, Rossignol M, Schurando P, Barranger E, Mebazaa A, Gayat E. Emergency hysterectomy for life-threatening postpartum haemorrhage: risk factors and psychological impact. Gynécologie Obstétrique & Fertilité. 2015 Dec 1;43(12):773-9.

25. Cowan, A.D., Miller, E.S. and Grobman, W.A. Subsequent Pregnancy Outcome after B-Lynch Suture Placement. Obstetrics & Gynecology. 2014; 124(3): p558-561 

26. Doumouchtsis, S.K., Papageorghiou, A.T. and Arulkumaran, S. Systematic Review of Conservative Management of Postpartum Hemorrhage: What to Do When Medical Treatment Fails. Obstetrical & Gynecological Survey.2007; 62(8):540-547.

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