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Cojocaru L, Lankford A, Galey J, et al. Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss. J Matern Fetal Neonatal Med. 2020;1-10doi: 10.1080/14767058.2020.1852213.
Cojocaru, L., Lankford, A., Galey, J., Bharadwaj, S., Kodali, B. S., Kennedy, K., Goetzinger, K., & Turan, O. M. (2020). Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss. 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, 1-10. https://doi.org/10.1080/14767058.2020.1852213
Cojocaru, Liviu, et al. "Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss." 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 vol. (2020): 1-10. doi: https://doi.org/10.1080/14767058.2020.1852213
Cojocaru L, Lankford A, Galey J, Bharadwaj S, Kodali BS, Kennedy K, Goetzinger K, Turan OM. Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss. J Matern Fetal Neonatal Med. 2020 Dec 03;1-10. doi: 10.1080/14767058.2020.1852213. Epub 2020 Dec 03. PMID: 33272057.
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J Matern Fetal Neonatal Med. 2020 Dec 03;1-10. doi: 10.1080/14767058.2020.1852213. Epub 2020 Dec 03.

Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss.

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

Liviu Cojocaru, Allison Lankford, Jessica Galey, Shobana Bharadwaj, Bhavani S Kodali, Kelly Kennedy, Katherine Goetzinger, Ozhan M Turan

Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA.
  2. Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
  3. Department of Obstetrics, Gynecology and Reproductive Science, Center for Advanced Fetal Care, University of Maryland Medical Center, Baltimore, MD, USA.

PMID: 33272057 DOI: 10.1080/14767058.2020.1852213

Abstract

OBJECTIVE: To evaluate whether the implementation of our surgical approach, referred to in the text as Linear Cutter Vessel Sealing System (LCVSS) technique, will improve perioperative outcomes in patients with placenta accreta spectrum (PAS), specifically by reducing blood loss and blood transfusion rates at the time of cesarean hysterectomy (C-HYST). The LCVSS technique integrates the following: (1) hysterotomy performed using the Linear Cutter, (2) no placental manipulation, (3) cauterization of anatomically prominent vascular anastomosis using the handheld vessel sealing system, and (4) completion of bladder dissection until the cervico-vaginal junction before ligation and division of uterine arteries.

MATERIALS AND METHODS: This is a retrospective cohort study that analyzed perioperative outcomes in patients undergoing C-HYST for PAS at a tertiary care center from 1 July 2014 to 1 December 2019. Comparisons were performed between cases managed with the use of the LCVSS technique (designated as LCVSS cohort) and those managed without the use of the LCVSS technique (designated as no technique cohort). The primary outcomes were cumulative blood loss (CBL) and total perioperative blood transfusion of ≥4 and ≥6 units of PRBCs. The secondary outcomes were intra- and postoperative complications. Continuous and categorical variables were compared according to the sample size and distribution. Binary logistic regression analysis was performed to predict confounders for blood transfusion of ≥4 units of PRBCs.

RESULTS: A total of 69 prenatally diagnosed PAS cases underwent C-HYST at the time of delivery. Forty-four cases that were performed using the LCVSS technique comprised the LCVSS cohort. The remaining 25 were marked as no technique cohort. CBL was significantly lower in the LCVSS cohort (1124 ml [300-4100] vs 3500 ml [650-10600];

CONCLUSION: Implementation of this advanced surgical approach for PAS management resulted in reduced blood loss and blood transfusion rates in comparison with no technique cohort.

Keywords: Placenta accreta spectrum; cesarean hysterectomy; obstetrics; surgery;  of excellence

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