TITLE:
Modified Triple P Approach by Gynecologic Oncologist-Led Team for Placenta Accreta Spectrum Improves the Outcome: Non-Randomized Controlled Trial
AUTHORS:
Mohammad Am Ahmed, Mostafa M. Khodry
KEYWORDS:
Placenta, Accreta, Gynecologic, Oncologist, Surgery, Outcome
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.7,
July
25,
2019
ABSTRACT: Introduction: Placenta Accreta Spectrum
(PAS) is associated with significant maternal and fetal morbidity and
mortality. The ideal conservative management still does not exist. We aimed to
compare the outcome of cesarean section for PAS by a gynecologic oncologist-led
team using the modified triple P approach and by a non-gynecologic
oncologist-led team. Material and Methods: This is non-randomized controlled trial. Group A had
Cesarean Section by gynecologic oncologist. Gynecologic oncologist-led team did
all Cesarean Section following a modified triple P approach. The first P is for
“Plan” the uterine incision. The second P for “Pelvic” devascularization by
internal iliac artery ligation. The third P is for Placenta non-separation with resection of the myometrium. Group B had
Cesarean Section by non-gynecologic oncologist-led team. The main
outcome measures were the need for hysterectomy, amount of blood loss, and the
management-related complications. Results: Group A had significantly less estimated blood loss, and received less number of backed RBCs
units, and less operative time than group B. The uterus is preserved in all
cases of group A and in 50% of cases of group B. The overall maternal morbidity
rate was 17.5% in group A and 72.2% in group B. Conclusion: This
study provides evidence that the modified triple P approach for PAS by
gynecologic oncologist-led team presents lower maternal morbidity in comparison
to surgery by non-gynecologic oncologist-led team.