SURGICAL APPROACHES IN MORBIDLY ADHERENT PLACENTA: A COMPARATIVE ANALYSIS OF MYOMETRIAL RESECTION AND CAESAREAN SECTION HYSTERECTOMY
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Keywords
morbidly adherent placenta, myometrial incision, cesarean section
Abstract
Introduction: Morbidly adherent placentas pose serious health risks, often requiring hysterectomy during caesarean section. Recent research suggests myometrial resection as a potential alternative, especially for women planning future pregnancies, warranting a comprehensive comparison to inform evidence-based surgical strategies.
Objective: To assess the effectiveness and safety of surgical procedures for morbidly adherent placentas, this study will conduct a comprehensive comparative analysis of myometrial excision and caesarean hysterectomy.
Methodology: This prospective observational study was conducted at Bacha Khan Medical Complex from January, 2020 to December, 2022. Fifty people having a history of severe adherent placentas were part of the research group. Group B consisted of 35 patients who had myometrial excision, whereas group A consisted of 15 patients who underwent cesarean hysterectomy. Details regarding the procedure's type (elective or emergency), booking status, blood loss, additional compression sutures needed, post-procedure hospital stay, transfusion requirements, and complications were recorded using a self-created form. SPSS version 23 was used to do the statistical analysis.
Result: The study compared outcomes in two groups (Group A, n=15, and Group B, n=35) undergoing surgical procedures for morbid adherent placentas. Significant differences were observed in age distribution, mode of surgery, booking status, and parity. Clinical measures revealed significant disparities in blood transfusion requirements (p=0.003) but non-significant differences in postoperative hospital stay and gestational age of termination of pregnancy (TOP). Group B exhibited higher incidences of bladder injury, blood loss, re-laparotomy, and postoperative infections, highlighting the need for tailored approaches in managing complications associated with morbid adherent placentas in diverse patient cohorts.
Conclusion: There were less complications after myometrial resection compared to cesarean hysterectomy, including infection, blood loss, bladder damage, and relaparotomies, making it a safer and more reliable option.
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Dr Humeera Naz
Assistant Professor Gynae Department, Gajju Khan Medical College MTI, Shamansoor Swabi - Pakistan
Dr Bakth Ranra
Medical Officer Gynae Department, Batcha Khan Medical Complex, Shamansoor Swabi – Pakistan
Dr Parveen Shafi
HOD, Assistant Professor Gynae Department, Gajju Khan Medical College MTI, Shamansoor Swabi - Pakistan
Dr Faiza Naz
Gynecologist, Mardan Medical Complex, Mardan - Pakistan
Dr Zul-E-Huma
Assistant Professor Gynae Department, Gajju Khan Medical College MTI, Shamansoor Swabi - Pakistan
Dr Aneesa Sadiq
Assistant Professor Gynae Department, Gajju Khan Medical College MTI, Shamansoor Swabi - Pakistan