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Purpose: Placenta percreta is the most serious subtype of placenta accreta spectrum (PAS) disorders. In this study, we propose a new procedure for controlling intraoperative bleeding. We aimed at evaluating the effect and long-term outcomes of Partial Anterior Myometrial Resection and Reconstruction under tourniquet and/or prophylactic abdominal aorta balloon occlusion in patients with placenta percreta.Methods: This was a retrospective study involving pregnant patients with clinically confirmed placenta percreta who delivered by cesarean section between January 1st, 2018 and June 30th, 2020. A total of 334 pregnant women were recruited in this study. The 142 women that were subjected to this new method were regarded as the observation group while 194 pregnant women that were treated with other sutures were regarded as the control group. Demographic characteristics, placental accreta score, estimated blood loss (EBL), operative time, blood transfusion rate and volume, neonatal weight, post-operative hospital stays and costs were evaluated. Short-term complications, including fever, hematoma, thrombus, bladder rupture and ICU transfer rate, as well as long-term outcomes including breast feeding, menstruation, intrauterine adhesion, and chronic abdominal pain among others were followed up in the outpatient clinic and by phone calls.Results: For all cases, EBL in the observation and control groups were 1200 (687~1812) ml and 1300 (800~2500) ml; operative time were 99.5 (84.0~120.0) min and 109.0 (83.8~143.0) min; while lengths of postoperative hospital stays were 4 (4~7) and 5 (4~7.5) days, respectively. The observation group exhibited significantly better outcomes than the control group. There were no significant differences in placental percreta scores, costs, blood transfusion volume, neonatal weight, fever, hematoma, thrombus, bladder rupture and ICU transfer rates between the two groups. All patients, except one in control group, had preserved uterus. There were no statistically significant differences in short-term and long-term complications between the two groups.Conclusions: When combined with prophylactic abdominal aorta balloon occlusion and/or tourniquet, Partial Anterior Myometrial Resection and Reconstruction is highly effective in reducing intraoperative blood loss and hysterectomy in placental percreta. However, we should pay attention to short-term and long-term complications, especially to the complications associated with aorta balloon occlusion. |
