Title: Selective Devascularisation and Conservative Management in Adherent Placenta to Save the Uterus

Biography:

Hamdy Mohamed Talkhan is serving at General Organization of Teaching Hospitals, Egypt since 1993to till date. He has graduated from Al Sahel Teaching Hospital, and worked as Resident until Assistant Professor Obstetrics & Gynecology. He has been the Trainer and Examiner in Egyptian Board – Ob-Gyne. From 2008 – 2009, he was the Consultant & Head of OB-Gyne Department Mwasat Al-Jubail Hospital. From 2009 – 2014, worked as Consultant & Head of OB-Gyne Department of Prince Fahd Bin Sultan Hospital. Presently he is the Consultant & Head of OB-Gyne Department , GAMA Hospital since 2014.

 

 

Abstract

Introduction: Placenta accreta is a major challenge facing obstetricians nowadays owing to increased incidence of placenta accreta parallel to increased Caesarean Section rates. Although the age of patients with placenta accreta getting younger and fertility preservation is required, there is no definite planned management method widely accepted except for hysterectomy. Uterine sparing techniques were developed to prevent poor sequalae of hysterectomy but neither one methods proved to be superior to the other nor got wide acceptance by obstetricians and hysterectomy remains the most popular and accepted method for placenta accreta management as it minimize maternal morbidity and mortality.

Aim of the study: The aim of this study is to put the light on Uterine Sparing techniques aiming to preserve future fertility and, minimizing the poor sequalae of hysterectomy.

Patients and methods: 20 patients with abnormal adherent placenta previa varies between accreta, increta and percreta was managed in our hospital (Gama Hospital- Alkhobar, KSA) at the period from January 2017 to may 2018.  Most of them were referred to us from other hospitals and medical centers. Conservative methods and selective devascularization was done for all cases after evaluation.

Results: conservative methods and selective devascularization was succeeded to preserve the uterus and fertility for 19 cases but one case we obliged to do cesarean hysterectomy after failure of our management.

Conclusion: uterine sparing techniques getting world wide acceptance and applicability in cases of abnormal adherent placenta specially to preserve fertility. Our technique is selective devascularization by ligation of internal iliac and ovarian arteries bilaterally, modified b lynch suture and condum catheter insertion intrauterine.