Planned caesarean hysterectomy versus "conserving" caesarean section in patients with placenta accreta.
OBJECTIVE
Invasive placentation (placenta accreta, increta, or percreta) presents significant challenges at Caesarean section. Caesarean hysterectomy in such circumstances may result in massive blood loss despite surgical expertise. We reviewed two divergent surgical approaches: planned Caesarean hysterectomy versus a "conserving surgery" in which the placenta is left in situ after Caesarean section.


METHODS
We conducted a single-centre retrospective review of all patients who delivered with invasive placentation between 2000 and 2009. We included only patients with antenatally diagnosed invasive placentation and planned mode of delivery.


RESULTS
Twenty-six patients met the inclusion criteria. Caesarean hysterectomy was planned in 16 patients and conserving surgery in 10. Intraoperative and postoperative complications were comparable in the two groups. Four of 10 patients initially treated by conservative surgery required a subsequent hysterectomy for severe vaginal bleeding, coagulopathy, or sepsis. No pregnancies were subsequently reported in the conserving surgery group.


CONCLUSIONS
An initial conserving surgical procedure is an option in patients with extensive invasive placentation, but it requires further monitoring for potential complications and carries a high subsequent hysterectomy rate.
Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON.
Hagai
H
Amsalem
Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON.
John C P
JCP
Kingdom
Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON.
Dan
D
Farine
Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON.
Lisa
L
Allen
Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON.
Yoav
Y
Yinon
Department of Medical Imaging, Mount Sinai Hospital, Toronto ON.
Donna L
DL
D'Souza
Department of Medical Imaging, Mount Sinai Hospital, Toronto ON.
John
J
Kachura
Department of Medical Imaging, Mount Sinai Hospital, Toronto ON.
Sophia
S
Pantazi
Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON.
Rory
R
Windrim
D000328:Adult; D016063:Blood Loss, Surgical; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007431:Intraoperative Complications / Q000453:epidemiology; D010921:Placenta Accreta / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies