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2018, Number 1

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Rev Med UV 2018; 18 (1)

Placental accreta: Experience in Critical Obstetrics

Hernández MLD, Herrera VJE, Mendoza HF, Adaya LEA

Language: Spanish
References: 26
Page: 75-87
PDF size: 537.32 Kb.


ABSTRACT

Introduction. The multidisciplinary and protocolized management of the patient with diagnosis of placenta previa, plus placental accreta, decrease in the degree of obstetric hemorrhage, as well as maternal and fetal morbidity and mortality and without secondary sequelae. Objective. To present the experience of multidisciplinary and protocolized management of patients with placenta previa plus placental accreta in the service of obstetric critical medicine. Methodology. We performed a series of cases, evaluating demographic variables (age, weeks of gestation, births, cesarean sections, blood loss), diagnostic methods, blood loss, days of hospital stay, complications, surgical techniques, perinatal results, sampling is not probabilistic. consecutive cases. Results; 15 patients studied, with the following demographic characteristics; mean age of 31 ± 4.2 years, gestational age of 34.4 ± 2.7 weeks of gestation, Gestures 3.4 ± 1.3, deliveries of 0.21 ± 0.8, cesarean sections 2.0 ± 0.8, and a blood loss of 2659.17 ± 2377.90 milliliters, where a 50% course with shock grade IV and 50% grade III, use hemoderivatives in 100%, the main Acretismo placentario: Experiencia en Obstetricia Crítica complication was metabolic acidosis in 72%, the diagnosis was made with Doppler ultrasound in 100% of the cases, and the neonatal results were; APGAR 7.7 ± 2.2 and 8.9 ± 0.3 at minute and 5 minutes, weighing 2242.85 ± 751.11 grams, histopathological confirmatory results 40% focal accreta, 27% increta and 33% percreta, and the final treatment was subtotal hysterectomy plus ligature of hypogastric arteries 33%, and subtotal hysterectomy plus double catheter placement J 47%. With zero maternal deaths and no secondary sequelae. Conclusions: The participation of a multidisciplinary and protocolized team in the units of critical medicine and obstetrics, is fundamental for the successful management of placenta previa with accretion and the prevention of medical complications in obstetrics.


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