Objective:
We aimed to present our experience with the management of placenta invasion anomaly by reviewing clinical and operative features of the cases of cesarean hysterectomy performed due to placenta invasion anomaly.
Methods:
In this retropective study, the charts of all patients who underwent cesarean hysterectomy with an indication of placenta invasion anomaly in Istanbul Faculty of Medicine Department of Obstetrics and Gynecology between 2005 and 2012 were reviewed.
Results:
In this period a total of 85 patients underwent cesarean hysterectomy. 81 (95.3%) cases had experienced at least one cesarean delivery before. Majority of the operations (82.4%) were performed in elective conditions. In 16 (18.8%) cases bilateral hypogastric artery ligation was carried out because of profuse bleeding. There were no mortalities in the intra- or postoperative period. In 18 (21.2%) cases, intraoperative urology consultation was needed. Full- thickness bladder laceration occured in 17 patients, and partial cyctectomy was performed in one patient due to the placenta percreata invading posterior wall of the bladder. Transfusion was needed in 72 (84.7%) cases during and 50 (58.8%) patients after operation. Dilutional trombocytopenia developed in 17 (20%) patients due to massive transfusion. Histopathologically the diganosis was placenta accreata in 55 (64.7%), placenta increata in 1 (1.2%) and placenta percreata in 25 (29.4%) patients. The incidence of placenta invasion anomaly rose from 0.2% (7/3435) in 2005-2006 up to 0.8% (37/4344) in 2011-2012.
Conclusion:
The incidence of placenta invasion anomaly is increasing progressively. Cesarean hysterectomy being its classical treatment is an operation with a high risk of morbidity and it should be performed by experienced teams after appropriate preparations in tertiary centers where multidiciplinary approach is possible.
Keywords: Placenta invasion anomaly, placenta accreata, placenta increata, placenta percreata, cesarean hysterectomy