The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta.
The reported maternal mortality for morbidly adherent placenta ranges from 7% to 10% worldwide. Current treatment modalities for this potentially life-threatening condition include radical approaches such as elective peripartum hysterectomy with or without bowel/bladder resection or ureteric re-implantation (for placenta percreta infiltrating these organs), and conservative measures such as compression sutures with balloon tamponade and the placenta remaining in situ. However, both conservative and radical measures are associated with significant maternal morbidity and mortality. The present article describes the Triple-P procedure-which involves perioperative placental localization and delivery of the fetus via transverse uterine incision above the upper border of the placenta; pelvic devascularization; and placental non-separation with myometrial excision and reconstruction of the uterine wall-as a safe and effective alternative to conservative management or peripartum hysterectomy.
Department of Obstetrics and Gynaecology, St George's Healthcare NHS Trust, London, UK. edwin.c@sky.com
Edwin
E
Chandraharan
Sridevi
S
Rao
Anna-Maria
AM
Belli
Sabaratnam
S
Arulkumaran
D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008428:Maternal Mortality; D009215:Myometrium / Q000601:surgery; D058725:Peripartum Period; D010921:Placenta Accreta / Q000601:surgery*; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000601:surgery*; D011247:Pregnancy; D019651:Plastic Surgery Procedures / Q000379:methods*; D014599:Uterus / Q000601:surgery