Samsun Maternity Hospital, a Branch of Training and Research Hospital, Samsun, Turkey.
Department of Obstetrics and Gynecology, School of Medicine, Düzce University, Düzce, Turkey.
Ginekol Pol. 2021;92(5):359-364. doi: 10.5603/GP.a2020.0192. Epub 2021 Apr 12.
Morbidly adherent placenta (MAP) is one of leading causes of maternal mortality, with an increasing rate because of repeated cesarean sections (CS). The primary objective of this study is to compare two techniques of skin and uterine incisions in patients with MAP, evaluating the maternal fetal impact of the two methods. Retrospective multicentric cohort study.
A total of 116 women with MAP diagnosis were enrolled and divided in two groups. Group one, comprised of 81 patients, abdominal entry was performed by Pfannenstiel skin incision plus an upper transverse lower uterine segment (LUS) incision (transverse-transverse), which was 2-3 cm above the MAP border, with the uterus in the abdomen. In group two, comprised of 35 patients, abdominal entry was performed by an infra-umbilical midline abdominal incision, by vertical-vertical technique, and the pregnant uterus was incised by a midline incision (vertical) from the fundus till the border of the MAP. Total surgery time, blood loss, blood product consumption, total hospital stay, cosmetic outcomes, and postoperative complications were investigated.
Total time of surgery was significantly shorter in group 1 (p < 0.05). Intraoperative blood loss was higher in group 2. Difference between preoperative and postoperative Hb and Htc levels were 3.30 ± 1.04 and 12.99 ± 5.07 respectively (p = 0.012; p = 0.033). The use of erythrocyte suspension (ES), fresh frozen plasma (FFP), and cryoprecipitate and thrombocyte suspension (TS) were found to be significantly lower in patients of group 1than vertical-vertical group (p = 0.008, p = 0.009, p = 0.001, p = 0.001, respectively). There was no difference in terms of total length of hospital stay between groups.
In a subgroup of patients diagnosed for MAP, the transverse-transverse incision resulted in less bleeding, less blood and blood product use, and had better cosmetic results than vertical-vertical incision. Moreover, the total time of surgery, crucial for MAP patients, seems to be shorter also in transverse-transverse incision than in vertical-vertical incision.
胎盘粘连（MAP）是导致产妇死亡的主要原因之一，由于多次剖宫产（CS）的增加，其发生率也在不断增加。本研究的主要目的是比较两种 MAP 患者的皮肤和子宫切口技术，评估两种方法对母婴的影响。回顾性多中心队列研究。
共纳入 116 例 MAP 诊断患者，分为两组。一组 81 例，腹部入路采用 Pfannenstiel 皮肤切口加子宫上段横切口（LUS）（横-横），切口位于 MAP 边界上方 2-3cm，子宫在腹部。二组 35 例，腹部入路采用脐下正中腹部切口，采用垂直-垂直技术，妊娠子宫从中部至 MAP 边界行正中切口（垂直）切开。研究总手术时间、出血量、血制品用量、总住院时间、美容效果和术后并发症。
组 1 的总手术时间明显短于组 2（p<0.05）。组 2 的术中出血量较高。术前与术后 Hb 和 Htc 水平分别下降 3.30±1.04 和 12.99±5.07（p=0.012；p=0.033）。红细胞悬液（ES）、新鲜冷冻血浆（FFP）、冷沉淀和血小板悬液（TS）的使用在组 1 患者中明显低于垂直-垂直组（p=0.008，p=0.009，p=0.001，p=0.001）。两组总住院时间无差异。
在 MAP 诊断的患者亚组中，横-横切口的出血量较少，用血和血制品较少，美容效果较好，优于垂直-垂直切口。此外，对于 MAP 患者至关重要的总手术时间似乎也比垂直-垂直切口更短。
