Placenta accreta spectrum disorder: a comparison between fertility-sparing techniques and hysterectomy
| Autor: | Ömer Birol Durukan, Hüseyin Durukan, Faik Gürkan Yazıcı |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Placenta accreta media_common.quotation_subject medicine.medical_treatment Operative Time Fertility Placenta Accreta Hysterectomy Severity of Illness Index law.invention 03 medical and health sciences 0302 clinical medicine Pregnancy law medicine Humans Blood Transfusion Retrospective Studies Uterine Balloon Tamponade media_common Bakri balloon 030219 obstetrics & reproductive medicine business.industry Obstetrics Mortality rate Incidence (epidemiology) Fertility Preservation Obstetrics and Gynecology Length of Stay medicine.disease Intensive care unit Treatment Outcome 030220 oncology & carcinogenesis Female Tamponade business |
| Zdroj: | Journal of Obstetrics and Gynaecology. 41:353-359 |
| ISSN: | 1364-6893 0144-3615 |
| DOI: | 10.1080/01443615.2020.1755629 |
| Popis: | This study aimed to compare fertility-sparing interventions and hysterectomy among women with placenta accreta spectrum disorder (PAS) who underwent caesarean deliveries. We retrospectively reviewed the data, and classified 148 patients as follows: group B: Bakri balloon without resection (n = 83); group R: segmental uterine resection (n = 23); and group H: hysterectomy (n = 42). The groups differed significantly with respect to operative time, transfused blood products, and post-operative intensive care unit and hospital stays. Morbidity was the highest in group H. The aforementioned parameters did not differ between Groups B and R. Groups R and H differed regarding the operative time, post-operative hospital stay, and transfused blood products. Although the treatment modality and PAS severity differed between the groups of patients with preserved fertility, the surgical outcome parameters did not differ. Hence, the effectiveness of these approaches may be similar without foregoing patient safety.IMPACT STATEMENTWhat is already known on this subject? As caesarean delivery rates have increased worldwide, the incidence of placenta accreta spectrum disorder (PAS), which has high morbidity and mortality rates, has also risen. Planned caesarean hysterectomy is recommended to reduce mortality and morbidity, but fertility is lost.What do the results of this study add? The severity of PAS can range from mild to severe. A patient-tailored approach, which was based on the intra-operative findings and used either a Bakri balloon tamponade or segmental uterine resection, reduced morbidity and preserved fertility.What are the implications of these findings for clinical practice and/or further research? Instead of adhering to the conventional approach that involves an elective caesarean hysterectomy based on antenatal imaging, more suitable approaches should be considered from the spectrum of haemostatic and fertility-preserving options available, while considering a surgeon's experience, the intra-operative findings, and patients' needs. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|