[COMPARISON OF TWO APPROACHES FOR PLACENTA ACCRETA: UTERINE PRESERVATION VERSUS CESAREAN HYSTERECTOMY].

AIMS: To compare the maternal and newborn outcome between cases that underwent conservative surgery with uterine preservation (Group A) to cesarean hysterectomy (Group B).

BACKGROUND: Placenta accreta defines abnormally adherent and invasive placentation into the myometrium and in some cases invades adjacent organs. In recent years the incidence of placenta accreta cases has risen due to the increasing prevalence of cesarean delivery. The clinical manifestation of placenta accreta might be life threatening maternal bleeding during the attempt to detach the placenta following delivery. In cases where removing the placenta and controlling the bleeding is not possible, the last option is to perform cesarean hysterectomy.

METHODS: A retrospective cohort study, was conducted between the years 2004-2015, in order to compare the above two groups. The data are based on patients' records, surgeon reports and histopathologic specimens.

RESULTS: Data has been obtained from 148 patients, 49 (33%) of them underwent cesarean hysterectomy. For those who underwent cesarean hysterectomy, it has been found that the time of surgery was shorter, 68 minutes comparing to 113 minutes (P=0.000), there was less amount of blood loss, 965 ml versus 1658 ml (P=0.006), and shorter hospitalization, 8 days compared to 15 (P=0.004), in Group B versus A, respectively. In addition, only one patient from Group B developed fever following surgery (2.7%) compared to 22 patients (20.2%) in Group B versus A, respectively (P=0.009). The 1st and 5th min of Apgar scores were higher, 9,8 and 10,9 in the Group B versus Group A, respectively (P=0.027, P=0.000).

CONCLUSIONS: For parturient women who have completed their family planning, cesarean hysterectomy without detaching the placenta accreta is the safer treatment option.