Nonremoval of an abnormally invasive placenta at cesarean section with postoperative uterine artery embolization.
OBJECTIVE
To evaluate the outcome of three different modes of management of abnormally invasive placenta over a 6-year period.


METHODS
Retrospective cohort study.


METHODS
Tertiary hospital in Hong Kong.


METHODS
In 39 757 deliveries, 25 cases of abnormally invasive placenta were identified at cesarean section.


METHODS
Identification of cases by hospital database and review of medical records.


METHODS
Blood loss, blood transfusion requirement, operative time, duration of hospital stay, secondary postpartum hemorrhage and endometritis.


RESULTS
Six women were managed by leaving the placenta in situ and by postoperative uterine artery embolization. Ten women were managed by an extirpative approach and nine women with direct cesarean hysterectomy. The success rate of nonremoval of the placenta with uterine artery embolization was 4/6 (67%). The intraoperative blood loss, blood transfusion requirements and operation times were lowest in the group with nonremoval of the placenta, although a higher secondary complication rate and a longer hospital stay followed.


CONCLUSIONS
Nonremoval of an abnormally invasive placenta at cesarean section and prophylactic postoperative uterine artery embolization are an alternative to elective cesarean hysterectomy.
Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
Man Y
MY
Chung
Yvonne K Y
YK
Cheng
Simon C H
SC
Yu
Daljit S
DS
Sahota
Tak Y
TY
Leung
D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010921:Placenta Accreta / Q000175:diagnosis / Q000628:therapy*; D011184:Postoperative Period; D006473:Postpartum Hemorrhage / Q000517:prevention & control* / Q000628:therapy; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*
Abnormally invasive placenta; hysterectomy; placenta accreta; placenta increta; placenta percreta; retained placenta; uterine artery embolization