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Ginecología y obstetricia de México
Print version ISSN 0300-9041
Abstract
GARCIA-ESPINOSA, Maritza; MARTINEZ-TORRES, Jesús Arturo and CALDINO-SOTO, Felipe. Ligation of hypogastric arteries prior to delivery or modified obstetric hysterectomy in anomalous insertion of the placenta. Ginecol. obstet. Méx. [online]. 2022, vol.90, n.11, pp.869-885. Epub Jan 27, 2023. ISSN 0300-9041. https://doi.org/10.24245/gom.v90i11.7910.
OBJECTIVE:
To evaluate the advantages of performing and not performing "Hypogastric artery ligation prior to delivery or modified hysterectomy" in the surgical management of anomalous placental insertion.
MATERIALS AND METHODS:
A retrospective, cross-sectional, comparative, retrospective case series study conducted at the Unidad Médica de Alta Especialidad, Hospital de Ginecoobstetricia 4 Luis Castelazo Ayala, from 2013 to 2019. Inclusion criteria: patients with abnormal placental insertion who underwent hypogastric artery ligation before delivery or before modified obstetric hysterectomy, compared with those who did not have hypogastric artery ligation. Exclusion criteria: patients who did not terminate the pregnancy in the hospital or the information in the file was incomplete. Study parameters: transoperative bleeding, blood transfusion, postoperative morbidity and admission to intensive care. Outcomes were analyzed with descriptive and inferential statistics.
RESULTS:
285 patients were evaluated; 57% (n = 164) with placenta previa, 27% (n = 78) marginal and 15% (n = 43) normoinsert. The placenta accreta spectrum was found in 34% (n = 91) of the sample. In the placenta previa group, the application of the technique decreased transoperative bleeding (p = 0.005) and blood transfusion (p = 0.05). In patients with placenta accreta spectrum there was a reduction of transoperative bleeding (p < 0.01), lower blood transfusion (p = 0.01), intensive care admission (p < 0.001) and days of intensive care stay (p = 0.0001).
CONCLUSIONS:
Hypogastric artery ligation before delivery and before modified hysterectomy in the surgical treatment of anomalous placental insertion showed maximum benefit in the placenta previa and spectrum of placenta accreta groups.
Keywords : Pregnancy; Placenta previa; Placenta accreta; Hysterectomy; Blood transfusion; Arterias; Critical care; Morbidity.