Conservative management of placental invasion anomalies with an intracavitary suture technique

• Published in: International journal of gynecology and obstetrics 2018-11, Vol.143 (2), p.184-190
• Main Authors: Acar, Ali, Ercan, Fedi, Pekin, Aybike, Elci Atilgan, Adeviye, Sayal, Hasan Berkan, Balci, Osman, Gorkemli, Hüseyin
• Format: Article
• Language: English
• Subjects: Adult; Conservative management; Conservative Treatment - methods; Female; Fertility Preservation - methods; Humans; Hysterectomy - statistics & numerical data; Intracavitary suture; Placenta accreta; Placenta Accreta - surgery; Placenta increta; Placenta percreta; Placenta previa; Placenta Previa - surgery; Placental invasion anomaly; Postpartum Hemorrhage - prevention & control; Pregnancy; Prospective Studies; Suture Techniques; Uterine preservation; Young Adult
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.12593

Objective To assess the efficacy and safety of a new surgical suture technique for uterine preservation among patients with placental invasion anomalies. Methods The present prospective case series included women diagnosed with placental invasion anomalies undergoing cesarean deliveries who desired future fertility at the obstetrics department of a Turkish university hospital between January 10, 2013, and April 20, 2017. Patients were diagnosed with ultrasonography and Doppler ultrasonography; the type of placental invasion anomaly (placenta accreta, increta, or percreta) was confirmed intraoperatively. Surgical management involved an intracavitary suture technique after the proximal branch of the uterine artery was clamped and utero–ovarian anastomoses had been blocked. Outcomes included units of blood transfused, intraoperative and postoperative adverse events, duration of hospital admission, and hysterectomy rate. Results There were 62 patients included. The mean operative blood loss was 1350 ± 750 mL (range 600–5000 mL). Blood transfusion required a mean of four units (range 2–15). Bleeding was controlled with the intracavitary sutures in 58 (94%) patients. Three patients experienced postoperative wound infections and two patients developed endometritis that required therapy with broad‐spectrum antibiotics. The mean length of hospital stay was 3.6 ± 1.6 days (range 2–11). None of the patients required reoperation after the initial surgery. Conclusion The novel uterus‐sparing suture technique was highly effective among patients with placental invasion anomalies. The uterus‐sparing suture provided an effective technique to control bleeding in the absence of any other intervention among patients with placental invasion anomalies.