title: Conservative management of post-partum hemorrhage secondary to placenta previa-accreta with hypogastric artery ligation and endo-uterine hemostatic suture.
abstract: OBJECTIVE
  The aim of this study was to investigate maternal and neonatal outcomes of conservative management of post-partum hemorrhage due to placenta previa-accreta using hypogastric artery ligation and endo-uterine hemostatic suture to lower uterine segment.
  
  
  METHODS
  The records of 38 patients who were managed conservatively with hypogastric artery ligation and endo-uterine hemostatic suture to control post-partum hemorrhage secondary to placenta previa-accreta between April 2014 and January 2016, were reviewed retrospectively. Placenta previa-accreta was diagnosed according to gray-scale, color and 3-D power Doppler ultrasonography in addition to the intraoperative findings based on fragmentary or difficult separation of the placenta. In the case of conservative treatment protocol failure, cesarean hysterectomy was performed.
  
  
  RESULTS
  Of these patients, 55.2% were between 25 and 35 years old; 97.5% were multiparous; 71.2% had two or more previous cesarean section and 68.5% had preterm delivery. Women with placenta accreta had a median estimated blood loss of 450 mL; 57.8% of patients had blood transfusion (mean intraoperative transfusion, 2 units packed red blood cells; range, 0-9 units). Median duration of operation was 112.5 min (range, 45-305 min) and 32 patients (84.3%) with placenta accreta did not undergo cesarean hysterectomy.
  
  
  CONCLUSIONS
  Conservative treatment of post-partum hemorrhage secondary to placenta previa-accreta with hypogastric artery ligation and endo-uterine hemostatic sutures to the lower segment of the uterus is associated with lower hysterectomy rate compared with the other conservative methods reported in the literature.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Inonu, Malatya, Turkey.
authors.forename: Melekoglu
authors.initials: M
authors.lastname: Rauf
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Inonu, Malatya, Turkey.
authors.forename: Celik
authors.initials: C
authors.lastname: Ebru
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Inonu, Malatya, Turkey.
authors.forename: Eraslan
authors.initials: E
authors.lastname: Sevil
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Cukurova, Adana, Turkey.
authors.forename: Buyukkurt
authors.initials: B
authors.lastname: Selim
mesh_terms: D000328:Adult; D000072700:Conservative Treatment / Q000379:methods*; D005260:Female; D006490:Hemostatics; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008026:Ligation / Q000379:methods; D013513:Obstetric Surgical Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010921:Placenta Accreta; D010923:Placenta Previa; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011247:Pregnancy; D013536:Suture Techniques
chemical_list: D006490:Hemostatics
keywords: iliac artery; ligation; placenta accreta; placenta previa; post-partum hemorrhage