Efficacy and safety of management of placenta accreta spectrum by transverse uterine fundal incision in a single tertiary care centre: A retrospective study.

Kallol Kumar Roy, Rinchen Zangmo, Anamika Das, Gayatri Suresh, Rakhi Rai, Bhavana Girish, Archana Kumari, Vanamail P, Juhi Bharti, Seema Singhal, Jyoti Meena
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Abstract

Background We assessed the efficacy and safety of management of morbidly adherent placenta by the transfundal uterine incision approach. As a secondary outcome measure, we compared ultrasound and magnetic resonance imaging (MRI) for the diagnosis of adherent placenta. Methods We retrospectively analysed the records of 5 years of women with adherent placenta. Twenty-five women with an antenatal diagnosis of placenta increta and percreta operated by transfundal uterine incision were included. Blood loss, transfusion requirements, operative injuries, and maternal and neonatal intensive care unit (ICU) stay were compared among three different types of adherent placenta. Surgical and other outcome measures were also analysed. Results On antenatal screening with ultrasound, an accurate diagnosis could be achieved in all cases of increta and two-thirds of percreta. Antenatal diagnosis by MRI detected 93.3% of increta and all percreta cases. The mean (SD) gestation at delivery was 34 (4.9) weeks in accreta, 34.9 (2.7) weeks in increta and 31 (4.8) weeks in percreta patients. The mean blood loss encountered intraoperatively was 1012.5 (193.1) ml, 1566.67 (566.52) ml and 1591.67 (629.61) ml in accreta, increta and percreta patients, respectively. Inadvertent bladder injury occurred in 3 women who had placenta percreta invading the bladder. There was no long-term morbidity and no mortality. Conclusion Transfundal incision for delivery of baby is associated with the advantage of avoiding the placenta thereby minimizing blood loss.

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在一家三级医疗中心采用子宫底横切法处理胎盘早剥谱的有效性和安全性:回顾性研究。
背景 我们评估了采用经阴道子宫切口方法处理病态粘连胎盘的有效性和安全性。作为次要结果,我们比较了超声和磁共振成像(MRI)诊断粘连胎盘的方法。方法 我们回顾性分析了 5 年来有胎盘粘连的妇女的记录。纳入了 25 名产前诊断为增厚性胎盘和粘连性胎盘的产妇,她们均接受了经阴道子宫切开术。对三种不同类型的粘连胎盘的失血量、输血需求、手术损伤、产妇和新生儿重症监护室(ICU)的住院时间进行了比较。此外,还分析了手术和其他结果指标。结果 在产前超声筛查中,所有增厚型胎盘和三分之二的粘连型胎盘都能得到准确诊断。通过磁共振成像进行产前诊断,93.3% 的增大胎盘和所有包膜妊娠病例均被检出。胎盘早剥患者分娩时的平均妊娠周数为34(4.9)周,胎盘增大患者为34.9(2.7)周,胎盘早剥患者为31(4.8)周。阴道闭锁、阴道增大和阴道闭锁患者术中的平均失血量分别为 1012.5 (193.1) 毫升、1566.67 (566.52) 毫升和 1591.67 (629.61) 毫升。有 3 名胎盘浸润膀胱的产妇意外损伤了膀胱。没有长期发病和死亡病例。结论 经臀切口分娩婴儿具有避开胎盘的优势,从而将失血量降至最低。
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