Effect of Uterine Artery Clamping in Reducing Cesarean  Hysterectomy in Pregnancies Complicated by Placenta Accrete  Spectrum

Balen Mohammad  Jabar; Maryam Bakir  Mahmood; Taher Abdullah Hussein  Hawramy; Naz Azad  Abdullah

doi:10.56056/amj.2024.250

Authors

Balen Mohammad Jabar MBChB, KBMS/Obstetrics and Gynecology trainee; Sulaymaniyah Maternity Teaching Hospital-Sulaymaniyah-Kurdistan region/Iraq.
Maryam Bakir Mahmood MBChB, FICOG; Assistant Professor and Senior Lecturer in Obstetrics and Gynecology department at Medical collegeSulaymaniyah University-Kurdistan region/Iraq
Taher Abdullah Hussein Hawramy *MBChB, D.G.S, CABS, FACS, Consultant Surgeon, Sulaymaniyah-Kurdistan region/Iraq E-mail: [email protected]
Naz Azad Abdullah MBChB, CABOG, HDOG; Lecturer in Obstetrics and Gynecology department at Medical college-Sulaymaniyah University-Kurdistan region/Iraq

DOI:

https://doi.org/10.56056/amj.2024.250

Keywords:

Emergency cesarean section, Placenta accreta spectrum, Uterine artery ligation

Abstract

Background and objective: The placenta accreta spectrum is a major public health problem. Many interventional measures are used for controlling hemorrhage and preventing emergency caesarean hysterectomy. The aim of this study was to evaluate the role of uterine artery clamping in reducing maternal morbidity and mortality in pregnancies complicated by placenta accrete spectrum.

Methods: This is a retrospective case-control study implemented in the Sulaymaniyah Maternity Teaching Hospital in Sulaymaniyah city, Kurdistan region-Iraq through the period of 2 years from 1^st of June 2020, to 31^st of May, 2022. A sample of sixty pregnant women with placenta accreta spectrum surgically managed by elective cesarean section and divided into two study groups (32 women underwent elective cesarean section with uterine artery clamping [interventional group] and 28 women underwent elective cesarean section without uterine artery clamping [control group].

Results: The postoperative hemoglobin level was significantly higher in women of the interventional group with a mean of (10.1±0.7 gm/dL) compared to (9.3±1 gm/dL) in women of the control group. The mean of units of blood transfused was significantly lower in women of the interventional group with a mean of (1.3±0.6 units) compared to (3.1±1.4 units) in women of the control group. Also, there was a significant reduction in units of fresh frozen plasma in women of the interventional group with a mean of (0.9±0.6 units) compared to (2.9±1.5 units) in women of the control group.

Conclusions: The uterine artery clamping before placental separation is helpful in reducing the rate of maternal morbidity and mortality in pregnancies complicated by placenta accreta spectrum.

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References

Mogos MF, Salemi JL, Ashley M, et al. Recent trends in placenta accreta in the United States and its impact on maternal-fetal morbidity and healthcare-associated costs, 1998-2011. J Matern Fetal Neonatal Med 2016; 29:1077–82.

Cahill AG, Beigi R, Heine RP, Silver et al. Society of Gynecologic Oncology; American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Am J Obstet Gynecol. 2018; 219(6): B2-B16.

Marshall NE, Fu R, Guise J-M. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol 2011; 205: 262.e1–262.e8.

Özcan S, Karayalç?n R, Kanat P et al. Multiple repeat cesarean delivery is associated with increased maternal morbidity irrespective of placenta accreata. Eur Rev Med Pharmacol Sci 2015; 19(11):1959-63.

JauniauxE, CollinsS, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. 2018; 218(1):75-87.

Bartels HC, Postle JD, Downey P, Brennan DJ. Placenta Accreta Spectrum: A Review of Pathology, Molecular Biology, and Biomarkers. Dis Markers 2018; 2018:1507674.

Touhami O, Allen L, Flores Mendoza H, Murphy MA, Hobson SR. Placenta accreta spectrum: a non-oncologic challenge for gynecologic oncologists. Int J Gynecol Cancer 2022; 32:788– 98.

Eller AG, Bennett MA, Sharshiner M, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011; 117:331–7.

Hoffman MS, Karlnoski RA, Mangar D, et al. Morbidity associated with nonemergent hysterectomy for placenta accreta. Am J Obstet Gynecol 2010; 202: 628.e1–628.e5.

Jauniaux E, Bunce C, Grønbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis. Am J ObstetGynecol 2019; 221:208–218.

Nieto-Calvache AJ, Palacios-Jaraquemada JM, Osanan G et al. Lack of experience is a main cause of maternal death in placenta accreta spectrum patients. Acta ObstetGynecolScand 2021; 100:1445–53.

Allen L, Jauniaux E, Hobson S, Papillon-Smith J, Belfort MA. Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: nonconservative surgical management. Int J Gynaecol Obstet 2018; 140:281–90.

Cahill AG, Beigi R, Heine RP. Obstetric Care Consensus No. 7 Summary: placenta accreta spectrum. Obstet Gynecol 2018; 132:1519–21.

Hobson SR, Kingdom JC, Murji A, et al. No. 383-Screening, diagnosis, and management of placenta accreta spectrum disorders. J Obstet Gynaecol Can 2019; 41:1035–49.

Salim R, Chulski A, Romano S. Precesarean prophylactic balloon catheters for suspected placenta accreta. Obstet Gynecol 2015; 126:1022–28.

Meller CH, Izbizky GH, Otano L. Outcomes of planned compared with urgent deliveries using a multidisciplinary team approach for morbidly adherent placenta. Obstet Gynecol 2018; 131:1164–5.

Søvik E, Stokkeland P, Storm BS. The use of aortic occlusion balloon catheter without fluoroscopy for life-threatening post-partum haemorrhage. Acta Anaesthesiol Scand 2012; 56:388.

Lin J, Lin F, Zhang Y. Uterine artery ligation before placental delivery during caesarean in patients with placenta previa accreta. Medicine (Baltimore) 2019; 98(36): e16780.

Showman HA, Alizzi FJ, Helmi ZR, Ismael VA, Fawzi HA. Placenta accrete spectrum disorders: A single centre experience over four years in the view of international guidelines. J Pak Med Assoc 2019; 69(Suppl 3) (8): S68-S72.

Ahmed HM, Ghanim NA. Rate and indications of cesarean section in the Maternity Teaching Hospital in Erbil City, Kurdistan region, Iraq. Zanco J Med Sci. 2018; 22(2): 148–54. Available from: https://doi.org/10.15218/zjms.2018.020

Pegu B, Thiagaraju C, Nayak D, Subbaiah M. Placenta accreta spectrum-a catastrophic situation in obstetrics. Obstet Gynecol Sci 2021; 64(3):239-47.

El Gelany S, Mosbeh MH, Ibrahim EM, et al. Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study. BMC Pregnancy Childbirth 2019; 19(1):313.

Turanv OM, Shannonv A, Asogluv MR, Goetzinger KR. A novel approach to reduce blood loss in patients with placenta accreta spectrum disorder. J Matern Fetal Neonatal Med 2021; 34(13):2061-70.

Abdulla N, Ghafel DH. Placental complications among Iraqi Pregnant Women with Placenta Accreta. Kufa Journal for Nursing Sciences 2021; 11(1): 1–8. Available from: https://journal.uokufa.edu.iq/index.php/kjns/article/view

Mohr-Sasson A, Hochman R, Anteby M, the management of placenta accreta spectrum disorder—A comparative study. Acta Obstet Gynecol Scand 2020; 99:1374–80. Available from: https://doi.org/10.1111/aogs.13868

Aryananda RA, Aditiawarman A, Gumilar KE. Uterine conservative–resective surgery for selected placenta accreta spectrum cases: Surgical–vascular control methods. Acta Obstet Gynecol Scand 2022; 101:639–48.

Verit FF, Çetin O, Keskin S, Akyol H, Zebitay AG. Does bilateral uterine artery ligation have negative effects on ovarian reserve markers and ovarian artery blood flow in women with postpartum hemorrhage? Clin Exp Reprod Med 2019; 46(1):30-5.

Liu W, Yin W. Effect of Uterine Artery Ligation and Uterine Artery Embolization on Postpartum Hemorrhage Due to Uterine Asthenia after Cesarean Section and Its Effect on Blood Flow and Function of Uterine and Ovarian Arteries. J Healthc Eng 2022; 2022:1337234.

Kale A, Aksu S, Terzi H, Demirayak G, Turkay U, Sendag F. Uterine artery ligation at the beginning of total laparoscopic hysterectomy reduces total blood loss and operation duration. J Obstet Gynaecol 2015; 35(6):612-5.

Butwick AJ, Goodnough LT. Transfusion and coagulation management in major obstetric hemorrhage. Curr Opin Anaesthesiol 2015; 28(3):275-84.

Verspyck E, Resch B, Sergent F, Marpeau L. Surgical uterine devascularization for placenta accreta: immediate and long-term follow-up. Acta Obstet Gynecol Scand 2005; 84(5):444-7.