Meeting paper
SAAOG paper
Morbidity associated with nonemergent hysterectomy for placenta accreta

Presented at the 72nd Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists, Naples, FL, Jan. 10-13, 2010.
https://doi.org/10.1016/j.ajog.2010.03.021Get rights and content

Objective

The purpose of this study was to report the morbidity of nonemergent hysterectomy for suspected placenta accreta.

Study Design

This was a retrospective study of all patients who underwent nonemergent hysterectomy for placenta accreta at Tampa General Hospital from June 1, 2003 to May 31, 2009.

Results

Twenty-nine patients were identified. Diagnosis was suspected on ultrasound scanning in 26 women (6 women also underwent magnetic resonance imaging) and on direct vision at repeat cesarean section delivery in 3 women. All of the women were multiparous, and 18 women had undergone ≥2 cesarean section deliveries. Twenty-one women had a placenta previa, and 8 women had a low anterior placenta. Final pathologic findings revealed accreta (20 specimens), increta (6 women), and percreta (3 women). Mean total operative time was 216 minutes; blood loss was 4061 mL. Two women had ureteral transection (1 was bilateral); 3 women had cystotomy, and 3 women had partial cystectomy. Postoperative hemorrhage occurred in 5 women; 1 hemorrhage resolved after catheter embolization, and the other 4 hemorrhage required reoperation.

Conclusion

Nonemergent hysterectomy for placenta accreta is associated with significant morbidity in the forms of hemorrhage and urinary tract insult.

Section snippets

Materials and Methods

This was a retrospective, institutional review board–approved, chart review of all patients who underwent nonemergent hysterectomy for suspected placenta accreta from June 1, 2003 through June 30, 2009. Cases were identified through a medical records department and labor and a delivery records search with ICD-9 codes and search words (placenta accreta, cesarean hysterectomy). Patients whose surgery was precipitated by bleeding that was nonemergent in nature were included. Cesarean section

Results

Thirty-seven patients were identified in the database. Eight surgeries that were clearly emergent were excluded, which left 29 patients whose data were available for analysis. Patient characteristics are given in Table 1. Diagnosis was suspected on ultrasound scanning in 26 women (6 diagnoses were magnetic resonance imaging) and on direct vision at repeat cesarean section delivery in 3 women. Nine of the 29 patients were referred from the region based on the suspected diagnosis. Nine of the

Comment

Most patients in the present series were suspected preoperatively of having placenta accreta. It is likely that antenatal diagnosis has contributed to the overall drop in maternal morbidity and deaths that has been associated with this condition.1, 2 Physicians must maintain a high level of suspicion, particularly in patients with risk factors such as multiparity (especially previous cesarean section deliveries) in association with placenta previa.3, 4, 5

Antenatal diagnosis of placenta accreta

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    Authorship and contribution to the article is limited to the 7 authors indicated. There was no outside funding or technical assistance with the production of this article.

    Reprints not available from the authors.

    Cite this article as: Hoffman MS, Karlnoski RA, Mangar D, et al. Morbidity associated with nonemergent hysterectomy for placenta accreta. Am J Obstet Gynecol 2010;202:628.e1-5.

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