Predictors of postoperative hospitalisation in women who underwent the Triple-P Procedure for abnormal invasion of the placenta

Abstract

The ‘Triple-P Procedure’ is a conservative surgical alternative to peri-partum hysterectomy; it involves Peri-operative placental localisation and delivery of the foetus above the placenta, Pelvic devascularisation, and Placental non-separation with myometrial excision and uterine wall reconstruction. Our aim was to determine the factors influencing the duration of post-operative hospitalisation in women undergoing the procedure. A retrospective analysis of 24 patients was performed. The results were; 4 had additional measures (compression sutures and intrauterine balloon tamponade), 2 had co-morbidities, 3 undergoing intra and post-operative complications. We concluded that in those who had the procedure alone, the mean of hospitalisation was 4.2 days, compared to 5.5 days for those who had the complications mentioned above (p < .001). Regarding placental position, 19 had anterior, 4 had posterior and 1 had cornual placenta. The resulting blood loss mean was 3, 1.3 and 1.1 L, respectively, which explains that the blood loss is greater with anterior placenta compared to posterior and cornual invasion.

Impact statement

• What we already know: Abnormal invasion of the placenta is associated with a maternal mortality rate of 7–10% worldwide. The conventional management options are surgical peri-partum hysterectomy and conservative intentional retention of placenta, which are associated with post-operative morbidity and mortality. Therefore, the need for a new approach is mandatory.

• What the results of this study add: The Triple-P Procedure is a conservative surgical technique associated with a low incidence of complications, as reflected by the short period of post-operative hospitalization.

• The implications of the findings for practice and/or further research: This research emphasis that more attention needs to be paid to pregnant women with co-morbidities and anterior abnormal invasion of placenta: as they are at great risk for bleeding. post-operative complications and prolonged hospital stay.

Keywords:

• Abnormal invasion of placenta
• peri-partum hysterectomy
• the Triple-P Procedure
• massive obstetric haemorrhage
• myometrial excision
• placenta percreta

Disclosure statement

The authors report no declaration of interests.