Taiwanese Journal of Obstetrics & Gynecology (Dec 2004)
Emergency Peripartum Hysterectomy due to Placenta Previa/Accreta: 10 Years' Experience
Abstract
Objective: To identify risk factors for and sonographic findings, complications and outcomes of emergency peripartum hysterectomy due to placenta previa/accreta. Materials and Methods: This was a retrospective review and descriptive study of women who underwent emergency peripartum hysterectomy due to placenta previa/accreta at Chang Gung Memorial Hospital between 1992 and 2001. All emergency peripartum hysterectomies were considered by the responsible physician to be a lifesaving procedure. Each chart was reviewed with emphasis on risk factors, sonographic findings, complications and outcomes. Results: There were 16 cases of emergency peripartum hysterectomy due to placenta previa/accreta (0.6/1,000 births). The mean hospitalization time was 8 days (range, 5–24 days) and the mean operation time was about 150 minutes (range, 85–335 mins). The estimated mean blood loss was 3,800 mL (range, 2,700–12,000 mL) and the mean amount of whole blood transfused was 15 units (range, 10–38 units). Two cases of bladder injury occurred when dissecting the bladder from the lower uterine segment and cervix. Conclusion: The association of placenta previa and prior cesarean delivery with placenta accreta and emergency peripartum hysterectomy is well documented. Emergency peripartum hysterectomy remains a potentially lifesaving procedure with which every practitioner of obstetrics must be familiar. In facilities that have interventional radiological services and well-trained angiographers available on a 24-hour basis, prophylactic placement of catheters for possible selective embolization may be considered in patients with placenta previa and a prior cesarean section and sonographic findings of placenta accreta. There should be a clear, tried and tested protocol for dealing with massive obstetric hemorrhage to decrease maternal morbidity and mortality.
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