“COMPARATIVE OUTCOME OF CESAREAN HYSTERECTOMY VERSUS MYOMETRIAL RESECTION AMONG PATIENTS OF MORBID ADHERENT PLACENTA”
Main Article Content
Keywords
Morbidly Adherent Placenta, Cesarean Hysterectomy, Myometrial Resection, Blood Loss, Postoperative Complications, Uterine Preservation, Maternal Outcomes
Abstract
Background: Placenta accreta, percreta, and morbidly adherent placenta (MAP) pose a great obstetric dilemma. The normal procedure, cesarean hysterectomy, is linked to high maternal morbidity because of complications such as excessive blood loss, infections, and increased recovery periods. On the other hand, myometrial resection is a conservative procedure that seeks to salvage the uterus and may have fewer complications and lead to speedier healing.
Objective: The purpose of the present study is to compare the maternal outcomes of cesarean hysterectomy and myometrial resection in patients with morbidly adherent placenta based on the blood loss, transfusion, hospitalization, and the after-effects.
Methods: The study was a retrospective comparative study that was carried out at Ganga Ram Hospital Lahore in the duration from January, 2025 to June, 2025. This was a sample of 16 patients with MAP who were separated into two groups: 8 undergoing cesarean hysterectomy and 8 undergoing myometrial resection. The blood loss, blood transfusion rates, hospital stay, and complications were taken and analyzed.
Results: The myometrial resection group experienced very little blood loss (mean 1,500 mL) compared to the cesarean hysterectomy group (mean 2,500 mL). Moreover, the myometrial resection group also needed fewer blood transfusions (25 per cent) than the hysterectomy group (75 per cent). This difference in the length of stay significantly reduced the stay in the hospital in the myometrial resection group (6 days) versus the hysterectomy group (10 days). The number of postoperative complications (e.g., infections and organ injuries) was lower in the group of myometrial resection.
Conclusion: Cesarean hysterectomy is a well-known operation with numerous adverse effects, including excessive blood loss, prolonged hospitalization, and complications. Myometrial resection can be used to provide an alternative option to the popular cesarean hysterectomy in a few instances of morbidly adherent placenta, with better maternal outcomes.
References
2. Hessami, K., Kamepalli, S., Lombaard, H.A., Shamshirsaz, A.A., Belfort, M.A., Munoz, J.L. (2025). Conservative management of placenta accreta spectrum is associated with improved surgical outcomes compared to cesarean hysterectomy: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 232(5), 432-52.
3. Soyer-Caliskan, C., Celik, S., Basbug, A., Hatirnaz, S., Guclu, M., Akbaba, E., Celik, H., Guleryuz, S., Tinelli, A. (2021). Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision. Ginekologia Polska, 92(5), 359-64.
4. Jafari, R.M., Najafian, M., Barati, M., Saadati, N., Jalili, Z., Poolad, A. (2022). Comparison of uterine preservation versus hysterectomy in women with placenta accreta: A cross-sectional study. International Journal of Reproductive BioMedicine, 20(9), 739.
5. Hatırnaz, Ş., Güler, O., Başbuğ, A., Cetinkaya, M.B., Kanat-Pektaş, M., Bakay, K., Çelik, S., Şentürk, Ş., Soyer-Çalışkan, C., Gürçağlar, A., Şahin, B. (2021). A comparative multicentric study on serosal and endometrial myomectomy during cesarean section: surgical outcomes. Journal of Investigative Surgery, 34(7), 687-94.
6. Ismail, N. (2025). Comparative outcomes of planned cesarean hysterectomy and conservative management in placenta accreta spectrum: a narrative review. Asian Journal of Medical Health, 23(3), 1-5.
7. Okçu, N.T., Uysal, G., Gürbüz, T., Nazik, H., Narin, R. (2022). Investigating the quality-of-life scale in patients with placental adhesion disorder undergoing a cesarean hysterectomy and partial uterine resection. The European Research Journal, 8(5), 554-59.
8. Morsi, H., Monir, H.H., Borg, T.F., Amr, E.S., Elsenity, M.A. (2025). Comparison between bladder dissection at the beginning of cesarean section for morbidly adherent placenta and between delaying dissection until planning for cesarean hysterectomy. The Egyptian Journal of Hospital Medicine, 98, 764-71.
9. Yazdani, T., Zaheer, F., Amin, N., Mukhtar, S. (2022). Focal resection of lower uterine segment for morbidly adherent placenta: An alternative to obstetric hysterectomy. Pakistan Armed Forces Medical Journal, 72(2), 792-6.
10. Saeed, S., Gul, U., Urooj, U., Khan, S. (2025). Innovative Surgical Strategies for Morbidly Adherent Placenta: Optimizing Outcomes and Minimizing Maternal Morbidity. Pakistan Armed Forces Medical Journal, 75(5).
11. Rehman, S., Bilqis, H., Deeba, F., Sheyryar, S., Urooj, A., Khan, S. (2022). Morbidly adherent placenta: A cross-sectional study in a tertiary care hospital. Pakistan Journal of Medicine and Dentistry, 11(4), 50-4.
12. Gobran, M.A., Hafeez, A., ElShafie, R.M., Ibrahim, S.A., Ramadan, M.S. (2024). Evaluation of pregnancy outcomes & different management options used in Morbid Adherent placenta. Zagazig University Medical Journal, 30(3), 722-30.
13. Naz, F., Siyal, S., Mallah, N. (2025). Maternal and Foetal Outcomes in Cesarean Hysterectomies Performed for Placenta Increta. Indus Journal of Bioscience Research, 3(2), 792-6.
14. Abd Elhameid, A.A., Ibrahem, M.A., Mohammed Alfiqi Alshireef, A.A., Abd-Alkader, A.M. (2025). Effect of Bladder Dissection Timing During Cesarean Hysterectomy for Morbidly Adherent Placenta on Maternal Outcomes. Zagazig University Medical Journal, 31(6), 2446-56.
15. Roseli, A., Bayuaji, H., Aziz, M.A. (2025). Comparison of Maternal Outcomes Between Cesarean Hysterectomy and Wedge Resection in Pregnant Women with Figo Grade 2 Placenta Accreta Spectrum. International Journal of Women's Health, 4975-80.
16. Kim, Y.H. (2023). Predictive model of Cesarean hysterectomy accompanying Cesarean section in patients with placenta previa. Clinical and Experimental Obstetrics & Gynecology, 50(4), 75.
17. Zhan, Y., Lu, E., Xu, T., Huang, G., Deng, C., Chen, T., Ren, Y., Wu, X., Yu, H., Wang, X. (2024). Cesarean hysterectomy in pregnancies complicated with placenta previa accreta: a retrospective hospital-based study. BMC Pregnancy and Childbirth, 24(1), 634.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Sadyia Gul
Post Graduate Resident, Department of Obstetrics and Gynaecology, MTI/ Mardan Medical Complex, Mardan, KPK
Dr Hina Akhtar
Assistant Professor, Department of Obstetrics and Gynaecology, Fatima Jinnah Medical University, Lahore, Punjab
Dr Shazia Zulfiqar
Assistant Professor Obstetrics and Gynaecology, LMDC (Lahore medical and dental college)/ GTTH (Ghurki Trust Teaching Hospital), Lahore, Punjab
Dr Hina Ayub
Associate Professor Obstetrics and Gynecology, Gomal Medical College, MTI D.I. Khan, KPK
Dr Samina Firdous
Assistant Professor, Department of Obstetrics and Gynaecology, Pak International Medical College Peshawar, KPK
Dr Shamim Akhtar
Associate Professor Gynae Obs, Kuwait Teaching Hospital Peshawar Medical College
