A new technique to preserve the uterus in patients with placenta accreta spectrum disorders

• Published in: American journal of obstetrics and gynecology Vol. 230; no. 3; pp. S1107 - S1115
• Main Authors: Barinov, Sergey V., Di Renzo, Gian Carlo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024
• Subjects: 2-layer horizontal 8-shaped stitches; bilateral ligation of the descendent branches of uterine arteries; blood transfusion; cesarean delivery; hemotransfusion; hysterectomy; metroplasty; obstetrical bleeding; placenta accreta spectrum; uterine compression suture; Zhukovsky double-balloon tamponade; blood transfusion; Zhukovsky double-balloon tamponade; placenta accreta spectrum; obstetrical bleeding; 2-layer horizontal 8-shaped stitches; hemotransfusion; hysterectomy; metroplasty; uterine compression suture; cesarean delivery; bilateral ligation of the descendent branches of uterine arteries
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2023.07.012

Placenta accreta spectrum disorders are associated with substantial maternal morbidity and mortality. Despite a preoperative diagnosis, the rate of complications remains high, and the condition is generally associated with the need for a hysterectomy. This study aimed to evaluate the outcomes of a new uterine-preserving technique (called the combined approach, including surgical hemostasis, bilateral ligation of the descending branches of the uterine arteries, and hemostatic external supraplacental stitch with the use of the Zhukovsky double-balloon tamponade in patients with placenta accreta spectrum disorders) during cesarean delivery in women with placenta accreta spectrum disorders vs the surgical technique used until 2014. This retrospective cohort study included 147 patients with placenta accreta spectrum disorders who were divided into 2 groups: the study group (n=95) is to undergo cesarean delivery using the combined approach, and the control group (n=52) is to undergo the surgical technique used until 2014, which included bilateral uterine artery ligation, which is the transfusion of plasma, red blood cells, platelets, and protease inhibitors. The volume of blood loss was 1.5-fold lower (P=.0010), the number of blood transfusions was 5.1-fold lower (P=.026), and the rate of bladder injuries was 19-fold lower (P=.012) in the study group than that in the control group. The duration of hospital stay after delivery was 4 days lesser (P=.001) and the number of hysterectomies was 4.5-fold lower in the study group than in the control group (P=.023). The study groups did not differ in terms of placenta accreta spectrum type. The combined approach during cesarean delivery proved to be more effective than the surgical technique used until 2014 in reducing the number of hysterectomies, blood loss volume, number of blood transfusions, and duration of hospital stay in patients with placenta accreta spectrum disorders.