THE ROLE OF EARLY CLAMPING OF UTERINE ARTERY AND DELAYED PLACENTAL SEPARATION IN REDUCING CONSEQUENCES OF PLACENTA ACCRETA SPECTRUM (PAS) DISORDER

Volume 12 , Issue 4 , December 2022 , Pages 403-410

Authors

Tahir Abdullah Hussein 1 ; Naz Azad Abdullah 1 ; Maryam Bakr Mahmood 1 ; Jwan Maasoum Hawrami 2 ; Nigar Mohammed Salih Barzinj 2

1 College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

2 Director of Health, Ministry of Health, Kurdistan Region, Iraq.

DOI logo 10.17656/jsmc.10384

Keywords

Abstract

Background
Abnormal invasive placentation leads to massive intraoperative bleeding and maternal morbidity or death. The
current study aimed to evaluate the role of systemic pelvic devascularization technique in reducing cesarean
hysterectomy in pregnancies involved in PAS and its complication.
Objectives
To deterime role of early claming of uterine artery and delayed placental separation in reducing the consequences
of placenta accreta spectrum disorders
Patients and Methods
Case series research was done in a Maternity Teaching Hospital as a single center study on twenty high-risk
pregnant ladies at (32 to37 weeks) gestation diagnosed with placenta accrete through ultrasonography from the
first of January 2021 to the first of November 2021.
All patients were managed through the technique of delayed delivery of the placenta and early clamping
uterine artery at the level of the internal os of the cervix using two vascular clamps followed by immediate
ligation of the anterior branch of the internal iliac artery (IIA) in the retroperitoneal space within 1-2 minutes
which shows a significant reduction in blood loss at placental bed following placental delivery, neither of cases
ended by cesarean hysterectomy, written consent has been taken from the enrolled patients. A college has
approved the study of the medicine Ethical Committee /the University of Sulaimani. Data from the current
study has been analyzed using “IBM SPSS statistics version 25”.
Results
Among the patients who participated in the present study, the mean±SD of age was 37.1 ± 4.5 years range (30-
48) years old, and the mean±SD gestational age was 36 ± 1.5 range (32 to 38) weeks, their mean ±SD of BMI
(body mass index) was 28 ± 2.2 (range, 24 to 32). The mean±SD cesarean count was 2.8 ± 1.3 (range, 0-5).
The mean±SD of patients’ gravida and parity were 4.2 ± 1.6 (range,1-7) and 2.8 ± 1.4 (range,0-5), respectively.
The mean±SD operation time varies 93 ± 25.6 range (60 to 120 minutes ); neither of the cases ended by
hysterectomy, hemoglobin levels were also taken as part of the investigation, and its level preoperatively
means ± SD 11.4 ± 1.1( range, 9.9 to 13.9) and post-operatively mean ± SD level was 9.6 ± 1.2 (range, 7.2 to
11.1), significantly less blood loss seen intraoperatively and only 75% of them require blood transfusion and
only one-day hospital stay after the operation, no one requires the second laparotomy. Therefore, there was no
significant association between them; thence, the mentioned procedure is clinically beneficial.
Conclusion
This method did not need to cesarean hysterectomy, so it causes less blood loss and morbidity.

Statistics
  • Article view548
  • Downloads0
  • Published at21 December 2022

  • RIS
  • BibTeX
  • EndNote
  • Mendeley
  • APA (7th edition)
  • MLA (9th edition)
  • Chicago
  • Harvard
  • IEEE
  • Vancouver