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- Title
Surgical management of abnormally invasive placenta: a retrospective cohort study demonstrating the benefits of a standardized operative approach.
- Authors
Brennan, Donal J.; Schulze, Brittany; Chetty, Naven; Crandon, Alex; Petersen, Scott G.; Gardener, Glenn; Perrin, Lewis
- Abstract
<bold>Introduction: </bold>Abnormally invasive placenta is a major cause of maternal morbidity and mortality. The aim of this study was to assess the effectiveness of a standardized operative approach performed by gynecological oncologists in the surgical management of abnormally invasive placenta.<bold>Materials and Methods: </bold>We performed a retrospective analysis of all cases of morbid placental adherence managed at the Mater Mothers' Hospitals, Brisbane, Australia between January 2000 and June 2013. A standard operative approach involving extensive retro-peritoneal and bladder dissection before delivery of the fetus, was undertaken when a gynecological oncologist was present at the start of the procedure. Main outcome measures were estimated blood loss, transfusion requirements, and maternal and neonatal morbidity.<bold>Results: </bold>The study includes 98 cases of histologically confirmed abnormally invasive placenta. Median estimated blood loss for the entire cohort was 2150 mL (range 300-11 500 mL). Women were divided into three groups, (1) those who had a gynecological oncologist present at the start of the procedure (group 1; n = 43), (2) those who had a gynecological oncologist called in during the procedure (group 2; n = 23), and (3) those who had no gynecological oncologist involved (group 3; n = 32). Group 2 had a significantly higher blood loss than the other groups (p = 0.001) (median 4400 mL). Transfusion requirements were higher in groups 2 and 3 compared with group 1 (p = 0.004). Other maternal and neonatal morbidity was similar across all three groups.<bold>Conclusion: </bold>This study supports the early presence of a gynecological oncologist at delivery when abnormally invasive placenta is suspected and demonstrates that a "call if needed" approach is not acceptable for these complex cases.
- Subjects
PLACENTA abnormalities; GYNECOLOGIC surgery; PREGNANCY complications; MATERNAL mortality; OBSTETRICAL research; BLOOD transfusion; CESAREAN section; DELIVERY (Obstetrics); HYSTERECTOMY; OBSTETRICS; PLACENTA diseases; TREATMENT effectiveness; RETROSPECTIVE studies; SURGICAL blood loss
- Publication
Acta Obstetricia et Gynecologica Scandinavica, 2015, Vol 94, Issue 12, p1380
- ISSN
0001-6349
- Publication type
journal article
- DOI
10.1111/aogs.12768