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

Brennan, Donal J., Schulze, Brittany, Chetty, Navan, Crandon, Alex, Petersen, Scott G., Gardener, Glenn and Perrin, Lewis (2015) Surgical management of abnormally invasive placenta: a retrospective cohort study demonstrating the benefits of a standardized operative approach. Acta Obstetricia et Gynecologica Scandinavica, 94 12: 1380-1386. doi:10.1111/aogs.12768


Author Brennan, Donal J.
Schulze, Brittany
Chetty, Navan
Crandon, Alex
Petersen, Scott G.
Gardener, Glenn
Perrin, Lewis
Title Surgical management of abnormally invasive placenta: a retrospective cohort study demonstrating the benefits of a standardized operative approach
Journal name Acta Obstetricia et Gynecologica Scandinavica   Check publisher's open access policy
ISSN 1600-0412
0001-6349
Publication date 2015-12
Year available 2015
Sub-type Article (original research)
DOI 10.1111/aogs.12768
Open Access Status Not Open Access
Volume 94
Issue 12
Start page 1380
End page 1386
Total pages 7
Place of publication Chichester, West Sussex United Kingdom
Publisher John Wiley & Sons
Collection year 2016
Language eng
Formatted abstract
Introduction
Abnormally invasive placenta is a major cause of maternal morbidity and mortality. The aim of this study was to assess the effectiveness of a standardized operative approach performed by gynecological oncologists in the surgical management of abnormally invasive placenta.

Materials and methods
We performed a retrospective analysis of all cases of morbid placental adherence managed at the Mater Mothers’ Hospitals, Brisbane, Australia between January 2000 and June 2013. A standard operative approach involving extensive retro-peritoneal and bladder dissection before delivery of the fetus, was undertaken when a gynecological oncologist was present at the start of the procedure. Main outcome measures were estimated blood loss, transfusion requirements, and maternal and neonatal morbidity.

Results
The study includes 98 cases of histologically confirmed abnormally invasive placenta. Median estimated blood loss for the entire cohort was 2150 mL (range 300–11 500 mL). Women were divided into three groups, (1) those who had a gynecological oncologist present at the start of the procedure (group 1; n = 43), (2) those who had a gynecological oncologist called in during the procedure (group 2; n = 23), and (3) those who had no gynecological oncologist involved (group 3; n = 32). Group 2 had a significantly higher blood loss than the other groups (p = 0.001) (median 4400 mL). Transfusion requirements were higher in groups 2 and 3 compared with group 1 (p = 0.004). Other maternal and neonatal morbidity was similar across all three groups.

Conclusion
This study supports the early presence of a gynecological oncologist at delivery when abnormally invasive placenta is suspected and demonstrates that a “call if needed” approach is not acceptable for these complex cases.
Keyword Abnormally invasive placenta
Placenta accreta
Surgery
Morbidity
Gynecological oncology
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
Official 2016 Collection
School of Medicine Publications
 
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