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| Content Provider | Springer Nature : BioMed Central |
|---|---|
| Author | Mohamed Siraj, Shahul Hameed Tan, Kok Hian Wright, Ann M |
| Abstract | Objective We previously described a technique for repair of the myometrial defect at repeat Caesarean section which increases residual myometrial thickness thereby potentially reducing future niche-related complications. Here we describe how this technique can be modified for use for placenta accreta spectrum disorders, in line with emerging evidence that this is more a disorder of myometrial deficiency than morbid adherence. Design The surgical performance of peripartum hysterectomy was compared with that of the modified technique in all women having repeat Caesarean delivery for placenta accreta spectrum disorder in a tertiary unit in Singapore between December 2019 and October 2021. Methods Modification of the original technique involved the systematic delivery of the placenta starting from its most posterior attachment after uterine exteriorization. This is followed by the identification, mobilization, and apposition of the boundaries of myometrial defects as described previously. Results Ten women had Caesarean hysterectomy and ten had Caesarean section using the modified approach. Age and gestational age at delivery were similar for the two groups. Women in the modified technique group had had fewer prior Caesarean sections and had a lower body mass index. Operating time, estimated blood loss and need for transfusion were all lower in the myometrial repair group but without statistical significance. There were no visceral injuries in the repair group but there was one bladder injury in the hysterectomy group. Conclusion The modified approach provides an effective alternative to peripartum hysterectomy with favourable surgical profile and allows uterine conservation with restoration of myometrial thickness. |
| Related Links | https://bmcpregnancychildbirth.biomedcentral.com/counter/pdf/10.1186/s12884-023-05370-6.pdf |
| Ending Page | 8 |
| Page Count | 8 |
| Starting Page | 1 |
| File Format | HTM / HTML |
| ISSN | 14712393 |
| DOI | 10.1186/s12884-023-05370-6 |
| Journal | BMC Pregnancy and Childbirth |
| Issue Number | 1 |
| Volume Number | 23 |
| Language | English |
| Publisher | BioMed Central |
| Publisher Date | 2023-01-14 |
| Access Restriction | Open |
| Subject Keyword | Reproductive Medicine Maternal and Child Health Gynecology Caesarean section Isthmocele Residual myometrial thickness Placenta accreta spectrum disorders |
| Content Type | Text |
| Resource Type | Article |
| Subject | Obstetrics and Gynecology |
| Journal Impact Factor | 2.8/2023 |
| 5-Year Journal Impact Factor | 3.4/2023 |
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