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Two approaches for placenta accreta spectrum: B-lynch suture versus pelvic artery endovascular balloon.

Research paper by Maya Frank MF Wolf, Shlomit S Maymon, Oleg O Shnaider, Jonathan J Singer-Jordan, Ron R Maymon, Jacob J Bornstein, Joseph J Tovbin

Indexed on: 20 Dec '18Published on: 20 Dec '18Published in: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians



Abstract

Management of patients with placenta accreta spectrum (PAS) varies widely, and scarce data exist concerning its management. The current study compared two different surgical approaches in the management of PAS: the B-lynch approach (Group A) compared to the endovascular balloon catheters (Group B) Methods: A retrospective cohort study, in two tertiary university-affiliated hospitals between the years 2004 and 2015. Elective cesarean section was planned at 35-37 weeks of gestation. One center utilized the B-lynch approach and the second utilized the endovascular balloon catheter approach. The cesarean hysterectomy rate was significantly higher in the Group A approach compared to Group B (36.1 versus 29.2%, p = 0.00). The number of packed cells units administered during and postoperatively were higher in the Group A versus to Group B (p = 0.006 and 0.043 respectively). Overall, surgery length and hospitalization duration were shorter in patients who underwent cesarean hysterectomy compared with those who underwent uterine preservation (B-lynch or endovascular balloon catheters) (p = 0.000 and p = 0.004, respectively). The endovascular balloon technique seems a better option for uterine preservation due to less blood loss and higher postoperative hemoglobin level. Nevertheless for those women who have completed their family planning, cesarean hysterectomy with the placenta left in situ is the safer and more suitable option.

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