An examination by year of cases applied with caesarean hysterectomy because of placenta percreta in a tertiary centre: a retrospective cohort study.

ABSTRACT

OBJECTIVES: To examine cases applied with caesarean hysterectomy because of placenta percreta by comparing changes in treatment strategies and complications according to year. MATERIAL AND METHODS: A retrospective examination was made of 93 patients applied with caesarean hysterectomy with a diagnosis of placenta percreta in 5-year periods of 2005-2009, 2010-2014, and 2015-2019. Demographic characteristics were recorded, and previous caesareans, history of myomectomy and curettage, gestational weeks, and infant birthweight. Intraoperative and postoperative findings were recorded as operating time, length of stay in hospital and Intensive Care Unit (ICU), transfusion requirement, the amount of erythrocyte suspension (ES) and fresh frozen plasma (FFP) transfused, and requirement for massive transfusion. Anaesthesia type, complications, and the preferred skin-uterus incision were also recorded. RESULTS: The 93 patients comprised 8 cases in the period 2005-2009, 23 in 2010-2014, and 62 in 2015-2019. The number of previous caesarean procedures was observed to increase in parallel with these case numbers. A significant increase was observed in the gestational week of birth, and infant birthweight, and a decrease in operating times. In later years there was seen to be a lower amount of ES and FFP transfused and fewer patients with massive transfusion. Preoperative diagnosis of placenta percreta, the highest preference for general anaesthesia, selection of midline vertical skin incision and uterine fundal incision were greatest in the period 2015-2019. CONCLUSIONS: In cases with placenta percreta, of which there is an increasing incidence, maternal and infant outcomes can be optimised with prenatal diagnosis and planned caesarean hysterectomy by a multidisciplinary team with optimal prenatal preparation.