Evaluation of the holding-up uterus technique for placenta accreta spectrum cesarean hysterectomy in shocked patients with a high shock index: a case series study

• Published in: BMC surgery Vol. 24; no. 1; p. 23
• Main Authors: Takahashi, Jin, Orisaka, Makoto, Inoue, Daisuke, Kawamura, Hiroshi, Takahashi, Nozomu, Tsuyoshi, Hideaki, Shinagawa, Akiko, Kurokawa, Tetsuji, Yoshida, Yoshio
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.01.2024; BioMed Central; BMC
• Subjects: Ablation; Ablation (Surgery); Adhesion; Anesthesia; Balloon Occlusion - methods; Balloon treatment; Bladder; Blood Loss, Surgical; Blood pressure; Cervix; Cesarean hysterectomy; Complications; Dissection; Embolization; Female; Hemorrhage; Holding-up uterus technique; Hormones; Humans; Hysterectomy; Hysterectomy - methods; Iliac Artery; Maternal mortality; Methods; Morbidity; Multidisciplinary teams; Obstetrics; Occlusion; Placenta; Placenta Accreta - etiology; Placenta Accreta - surgery; Placenta accreta spectrum; Pregnancy; Preoperative intervention; Reproductive technologies; Retrospective Studies; Shock; Shock index; Surgery; Sutures; Thromboembolism; Thrombosis; Uterus; Uterus - surgery; Veins & arteries; Japan; Shock index; Placenta accreta spectrum; Holding-up uterus technique; Cesarean hysterectomy; Preoperative intervention
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-024-02311-8

Placenta accreta spectrum (PAS) cesarean hysterectomy is performed under conditions of shock and can result in serious complications. This study aimed to evaluate the usefulness of the "Holding-up uterus" surgical technique with a shock index (S.I.) > 1.5. Twelve patients who underwent PAS cesarean hysterectomy were included in the study. Group I had S.I. > 1.5, and group II had S.I. ≤ 1.5. Group I had more complications, but none were above Grade 3 or fatal. Preoperative scheduled uterine artery embolization did not result in serious complications, but three patients who had emergency common iliac artery balloon occlusion (CIABO) and a primary total hysterectomy with S.I. > 1.5 had postoperative Grade 2 thrombosis. Two patients underwent manual ablation of the placenta under CIABO to preserve the uterus, both with S.I. > 1.5. The study found that the "Holding-up uterus" technique was safe, even in critical situations with S.I. > 1.5. CIABO had no intervention effect. The study also identified assisted reproductive technology pregnancies with a uterine cavity length of less than 5 cm before conception as a critical factor.