Factors Contributing to Massive Blood Loss on Peripartum Hysterectomy for Abnormally Invasive Placenta: Who Bleeds More?

الملخص EN

Introduction.

To identify factors that determine blood loss during peripartum hysterectomy for abnormally invasive placenta (AIP-hysterectomy).

Methods.

We reviewed all of the medical charts of 11,919 deliveries in a single tertiary perinatal center.

We examined characteristics of AIP-hysterectomy patients, with a single experienced obstetrician attending all AIP-hysterectomies and using the same technique.

Results.

AIP-hysterectomy was performed in 18 patients (0.15%: 18/11,919).

Of the 18, 14 (78%) had a prior cesarean section (CS) history and the other 4 (22%) were primiparous women.

Planned AIP-hysterectomy was performed in 12/18 (67%), with the remaining 6 (33%) undergoing emergent AIP-hysterectomy.

Of the 6, 4 (4/6: 67%) patients were primiparous women.

An intra-arterial balloon was inserted in 9/18 (50%).

Women with the following three factors significantly bled less in AIP-hysterectomy than its counterpart: the employment of an intra-arterial balloon ( 4 , 448 ± 1 , 948 versus 8 , 861 ± 3 , 988 mL), planned hysterectomy ( 5 , 003 ± 2 , 057 versus 9 , 957 ± 4 , 485 mL), and prior CS ( 5 , 706 ± 2 , 727 versus 9 , 975 ± 5 , 532 mL).

Patients with prior CS (−) bled more: this may be because these patients tended to undergo emergent surgery or attempted placental separation.

Conclusion.

Patients with intra-arterial balloon catheter insertion bled less on AIP-hysterectomy.

Massive bleeding occurred in emergent AIP-hysterectomy without prior CS.