February 22nd, 2019

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Interval Hysterectomy Management Option for Placenta Percreta to Reduce Maternal Morbidity
Authors:  David A. Ossin, M.D., Christopher L. Dixon, M.D., Christopher S. Bryant, M.D., and Veronica L. Schimp, D.O.
  OBJECTIVE: To evaluate maternal outcomes of placenta percreta managed with uterine artery embolization immediately after cesarean delivery followed by interval hysterectomy.

STUDY DESIGN: This study was a retrospective chart review of 17 women with placenta percreta treated at a tertiary center between 2012 and 2015. Each patient was managed by a multidisciplinary team. Placenta percreta was diagnosed by radiological imaging or at the time of cesarean delivery. Postcesarean placenta was left in situ. Uterine artery embolization was performed following the completion of the cesarean procedure. Based on radiologic imaging, the patient would have repeat uterine artery embolization as needed for placental involution, followed by definitive hysterectomy.

RESULTS: Median total estimated blood loss for both cesarean delivery and hysterectomy was 1,250 mL (range, 700–4,800 mL). In our study 35% of patients did not require a blood transfusion. A total of 29% of interval hysterectomies were complicated by bladder injury requiring repair. There was no recorded ureteral injury, bowel injury, or maternal death during the study period.

CONCLUSION: Our finding suggests placenta percreta managed with interval hysterectomies can decrease maternal morbidity by reducing total blood loss and injury to peripheral organs.
Keywords:  hysterectomy, interval hysterectomy, maternal mortality, morbidly adherent placenta, placenta, placenta accreta, placenta percreta, pregnancy complications, uterine artery embolization, uterine scar
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