Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Benavides, López, Campos, Valencia, Burgos-Luna, and Messa); Latin American Group for the Study of Placenta Accreta Spectrum (Drs Nieto-Calvache, Benavides, López, Campos, Valencia, Burgos-Luna, and Messa).
Otamendi Hospital, Buenos Aires, Argentina (Dr Palacios-Jaraquemada).
Am J Obstet Gynecol MFM. 2023 Feb;5(2):100802. doi: 10.1016/j.ajogmf.2022.100802. Epub 2022 Nov 11.
There are 3 treatment options for placenta accreta spectrum: cesarean delivery with hysterectomy, expectant management, and uterine-sparing surgical techniques. One-step conservative surgery is the most extensively described conservative surgical technique, and it has extensive evidence supporting its usefulness; however, few groups apply it, most likely because of the misconception that it is a complex procedure that requires extensive training and is applicable to only a few patients.
This study aimed to evaluate the clinical outcomes of patients undergoing one-step conservative surgery in 4 placenta accreta spectrum reference hospitals and provided detailed steps for successfully applying this type of surgery.
This was a multicenter, descriptive, prospective study that described the outcomes of patients with placenta accreta spectrum treated in 4 reference hospitals for this condition. The patients were divided into those managed with one-step conservative surgery and those managed with cesarean delivery and hysterectomy.
Overall, 75 patients were included. One-step conservative surgery was possible in 85.3% of placenta accreta spectrum cases (64 patients). Intraoperative staging and placenta accreta spectrum topographic classification allowed for the selection of one-step conservative surgery candidates. The clinical outcomes of the 2 groups were similar, except for the frequency of transfusions (81.8% in the cesarean delivery and hysterectomy group vs 67.2% in the one-step conservative surgery group) and vascular interventions (27.3% in the cesarean delivery and hysterectomy group vs 4.7% in the one-step conservative surgery group), which were both higher in patients who underwent hysterectomy. In addition, the operation time was shorter in the one-step conservative surgery group (164.4 minutes vs 216.5 minutes).
One-step conservative surgery is a valid procedure in most patients with placenta accreta spectrum. It is an applicable technique even in scenarios with limited resources. However, its safe application requires knowledge of the topographic classification and the application of intraoperative staging.
胎盘植入谱系疾病有 3 种治疗选择：剖宫产伴子宫切除术、期待治疗和保留子宫的手术技术。一步式保守性手术是最广泛描述的保守性手术技术，有大量证据支持其有效性；然而，很少有小组应用它，最可能是因为它是一种复杂的手术，需要广泛的培训，并且只适用于少数患者的误解。
本研究旨在评估 4 家胎盘植入谱系疾病参考医院中接受一步式保守性手术的患者的临床结果，并提供成功应用这种手术类型的详细步骤。
这是一项多中心、描述性、前瞻性研究，描述了在 4 家参考医院治疗胎盘植入谱系疾病患者的结果。患者分为接受一步式保守性手术和接受剖宫产伴子宫切除术的患者。
总体而言，纳入了 75 名患者。在胎盘植入谱系疾病病例中，85.3%（64 名患者）可行一步式保守性手术。术中分期和胎盘植入谱系疾病的解剖分类允许选择一步式保守性手术候选者。两组的临床结果相似，除了输血频率（子宫切除术组为 81.8%，一步式保守性手术组为 67.2%）和血管介入（子宫切除术组为 27.3%，一步式保守性手术组为 4.7%），这些在接受子宫切除术的患者中更高。此外，一步式保守性手术组的手术时间更短（164.4 分钟比 216.5 分钟）。
在大多数胎盘植入谱系疾病患者中，一步式保守性手术是一种有效的方法。即使在资源有限的情况下，它也是一种适用的技术。然而，其安全应用需要了解解剖分类和术中分期的应用。
