Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Eur J Obstet Gynecol Reprod Biol. 2018 Sep;228:215-220. doi: 10.1016/j.ejogrb.2018.07.004. Epub 2018 Jul 4.
Cesarean hysterectomy for adherent placenta is associated with increased maternal morbidity due to massive hemorrhage requiring large volume blood transfusion, bladder or ureteric injury, intensive care unit (ICU) admission and prolonged hospital stay. There is an ongoing effort to improve the outcome of these women and measures to reduce blood loss.
The purpose of the present study was to develop an alternate surgical approach for performing a Cesarean hysterectomy in women with adherent placenta in order to reduce hemorrhage and urinary tract injuries, and thereby improve the maternal outcome.
A prospective observational study in a tertiary care hospital in North India. The surgical approach described in the present study was practiced in 12 women who underwent Cesarean hysterectomy for adherent placenta previa. In this approach, dissection of the bladder flap as close as to the cervix was made prior uterine incision and delivery of the baby. During dissection of the bladder flap, the blood vessels traversing between uterus and bladder were ligated and divided.
These 12 women underwent Cesarean hysterectomy under general anesthesia. The interval from induction of anesthesia to delivery of the baby ranged from 40 to 79 min, and none of the babies had birth asphyxia. No woman had bladder or ureteric injury. All women had histopathological proven adherent placenta, 5 had placenta percreta, one had placenta increta and 6 had placenta accreta. The average blood loss was 1.46 l and the mean number of blood transfusions was 2.1 units. None of the women required post-operative ventilatory support or ICU admission, and all women were discharged from hospital between 4 to 7 days following Cesarean hysterectomy CONCLUSION: The present series describes an alternate surgical approach for Cesarean hysterectomy in adherent placenta. Dissection of the bladder flap prior to delivery of the baby followed by hysterectomy reduced the hemorrhage and there was no bladder or ureteric injury. This surgical approach requires no additional resources and may easily be followed in a low-resource setting.
由于需要大量输血、膀胱或输尿管损伤、入住重症监护病房（ICU）和延长住院时间导致大量出血，剖宫产子宫切除术治疗粘连性胎盘与产妇发病率增加有关。目前正在努力改善这些女性的结局，并采取措施减少出血。
本研究旨在为粘连性前置胎盘产妇剖宫产子宫切除术提供一种替代手术方法，以减少出血和泌尿道损伤，从而改善产妇结局。
在印度北部的一家三级保健医院进行的前瞻性观察研究。本研究中描述的手术方法应用于 12 例因粘连性前置胎盘而行剖宫产子宫切除术的患者。在这种方法中，在切开子宫和娩出婴儿之前，尽可能靠近子宫颈切开膀胱瓣。在切开膀胱瓣时，结扎和切断穿过子宫和膀胱之间的血管。
这 12 名妇女在全身麻醉下接受了剖宫产子宫切除术。从麻醉诱导到分娩的时间间隔为 40 至 79 分钟，没有婴儿发生窒息。没有妇女发生膀胱或输尿管损伤。所有妇女均经组织病理学证实为粘连性胎盘，5 例胎盘植入，1 例胎盘穿透性植入，6 例胎盘粘连。平均出血量为 1.46 升，平均输血 2.1 单位。没有妇女需要术后通气支持或入住 ICU，所有妇女在剖宫产子宫切除术后 4 至 7 天出院。
本系列描述了粘连性胎盘剖宫产子宫切除术的另一种手术方法。在分娩前切开膀胱瓣，然后进行子宫切除术，可减少出血，且无膀胱或输尿管损伤。这种手术方法不需要额外的资源，在资源有限的环境中也很容易实施。
