A new approach to fertility-preserving surgery in patients with placenta accreta

Abstract

Background: The aim of this study was to evaluate the efficacy of a novel combined surgical approach utilising: (1) two autonomous balloon Zhukovsky catheters (vaginal and uterine), (2) bilateral ligation of the descending uterine artery branches, (3) external supraplacental pleated sutures, and (4) either excision of a small area of placenta accreta or full metroplasty, for the management of uterine bleeding associated with placenta accreta of various severity.

Materials and methods: The study included medical records of 92 pregnant women with placenta accreta undergoing a caesarean section. To evaluate the efficacy of the proposed management strategy, study participants were divided into three groups. In Group 1 (controls, n = 47), we utilised the combination of bilateral ligation, Barinov external supraplacental pleated sutures, and either excision of the tightly attached portion of placenta accreta or metroplasty. In Group 2 (n = 20), the abovementioned surgical techniques were additionally combined with balloon tamponade using an intrauterine Zhukovsky catheter. In Group 3 (n = 25), we additionally used an intravaginal Zhukovsky balloon catheter to enhance the efficacy of intrauterine tamponade.

Results: The use of an intrauterine balloon catheter combined with metroplasty was associated with a reduction in blood loss volume and blood transfusion rate by 1.9-fold, while the use of intravaginal balloon catheter reduced blood transfusion rate by 2.4-fold. The uterine balloon catheter reduced the risk of hysterectomy by 11-fold.

Conclusion: Simultaneous use of two Zhukovsky balloon catheters (intravaginal and intrauterine) during caesarean section facilitates fertility-preserving surgery in patients with placenta accreta even in the cases of low-segment bleeding, thereby representing a promising approach to management of these patients.

Keywords:

• Obstetric bleeding
• placenta praevia
• placenta accreta
• ligation of uterine vessels
• haemostatic external supraplacental pleated sutures
• intravaginal and intrauterine Zhukovsky balloon catheter

Disclosure statement

No potential conflict of interest was reported by the authors.