Surgical management of abnormally invasive placenta: a retrospective cohort study demonstrating the benefits of a standardized operative approach

• DOI: 10.1111/aogs.12768
• Publication Date: 2015-09-07T13:58:58Z
• Authors: Donal J. Brennan; Brittany Schulze; Naven Chetty; Alex Crandon; Scott G. Petersen; Glenn Gardener; Lewis Perrin
• Keywords: Adult; Placenta Diseases; Blood Loss, Surgical; Hysterectomy; 630; 2729 Obstetrics and Gynaecology; 03 medical and health sciences; 0302 clinical medicine; Gynecological oncology; Pregnancy; Risk Factors; Abnormally invasive placenta; Humans; Blood Transfusion; Retrospective Studies; Cesarean Section; Placenta accreta; Infant, Newborn; Delivery, Obstetric; 3. Good health; Obstetrics; Treatment Outcome; Workforce; Surgery; Female; Morbidity

Abnormally invasive placenta is a major cause of maternal morbidity and mortality. The aim this study was to assess the effectiveness standardized operative approach performed by gynecological oncologists in surgical management abnormally placenta.We retrospective analysis all cases morbid placental adherence managed at Mater Mothers' Hospitals, Brisbane, Australia between January 2000 June 2013. A standard involving extensive retro-peritoneal bladder dissection before delivery fetus, undertaken when oncologist present start procedure. Main outcome measures were estimated blood loss, transfusion requirements, neonatal morbidity.The includes 98 histologically confirmed placenta. Median loss for entire cohort 2150 mL (range 300-11 500 mL). Women divided into three groups, (1) those who had procedure (group 1; n = 43), (2) called during 2; 23), (3) no involved 3; 32). Group 2 significantly higher than other groups (p 0.001) (median 4400 Transfusion requirements 3 compared with group 1 0.004). Other similar across groups.This supports early presence suspected demonstrates that "call if needed" not acceptable these complex cases.