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Federación Mexicana de Ginecología y Obstetricia, A.C.

2022, Number 11

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Ginecol Obstet Mex 2022; 90 (11)

Ligation of hypogastric arteries prior to delivery and/or modified obstetric hysterectomy in anomalous insertion of the placenta

García-Espinosa M, Martínez-Torres JA, Caldiño-SF

Language: Spanish
References: 25
Page: 869-885
PDF size: 551.09 Kb.


ABSTRACT

Objective: To evaluate the advantages of practicing or not hypogastric artery ligation before delivery or opting for modified hysterectomy in the surgical treatment 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 anomalous placental insertion who underwent hypogastric artery ligation before delivery or who opted for modified hysterectomy. 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; 56% (n = 162) with placenta previa, 27% (n = 77) marginal and 17% (n = 46) 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: Ligation of hypogastric arteries before delivery or opting for modified hysterectomy in the surgical management of anomalous placental insertion was reflected in maximum benefit in the placenta previa and placental accreta groups.


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