ALTERNATIVE PROCEDURES TO HYSTERECTOMY IN THE MANAGEMENT OF INTRACTABLE POSTPARTUM HEMORRHAGE DURING CESAREAN SECTION FOR MAJOR PLACENTA PREVIA CENTRALIS AND ADVERSE EFFECT IN MATERNAL & NEONATAL OUTCOME
Mohamed M. Abdalla
Obstetrics and gynecology, Elgalaa Teaching Hospital
This study was conducted on 60 patients who had major placenta previa centralis, verified by trans-abdominal U/S, allocated into two groups, asymptomatic (30patients) & symptomatic (30 patients). The design of this study was to evaluate the effect of alternative procedures to hysterectomy in arresting post partum hemorrhage during cesarean section in major placenta previa centralis & their adverse effect in maternal & neonatal outcome. All women were subjected to medical & obstetric examination & laboratory investigation. The alternative procedures done include tight utero-cervical packing, four rows of annular compressible sutures , ligation of uterine vessels & internal iliac artery, and total abdominal hysterectomy & pelvic packing in cases of placenta previa accreta centralis. The result of the study showed very good effect of the alternative procedures to hysterectomy in complete arrest of postpartum hemorrhage during cesarean section for major placenta previa centralis in 95% of total cases. In 5% of total cases, abdominal hysterectomy was done due to major placenta previa accreta centralis. No maternal morbidity or mortality occurred. In asymptomatic group A, no neonatal morbidity or mortality, however in symptomatic group B, 23.3% of total cases of neonate improved , 26.6% of total cases of neonates admitted to ICU, 16.6% stayed for 1-2 weeks & improved, while 10% stayed for 3-4 weeks & terminated by neonatal death.
December 2011