Conservative Surgical Management with Triple P procedure for the Placenta Accreta with Cervical Invasion: Case report

• Maame Benko ^[1] ; Miriam Crespo Rodríguez ^[2] ; Edwin Chandraharan ^[3]
  1. [1] St George’s University Hospitals NHS Foundation Trust

     St George’s University Hospitals NHS Foundation Trust

     Reino Unido

     
  2. [2] Department of Obstetrics and Gynaecology of University Hospital Son Espases
  3. [3] Department of Obstetrics and Gynaecology of St. George’s University Hospitals NHS Foundation Trust, London, UK

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• Localización: Medicina balear, ISSN-e 2255-0569, ISSN 1579-5853, Vol. 35, Nº. 3, 2020, págs. 39-42
• Idioma: inglés
• Títulos paralelos:
  • Manejo quirúrgico conservador con procedimiento Triple P para la placenta acreta con invasión cervical: reporte de caso
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• Resumen
  • español

    La placenta accreta es una invasión anormal de la placenta en el miometrio que conlleva un riesgo obstétrico significativo. Desafortunadamente, la incidencia de esta afección está en aumento y parece estar relacionada con el aumento de los procedimientos quirúrgicos invasivos, como cesáreas, miomectomías y legrado uterino, entre muchos otros. Debido a su asociación con una morbilidad y mortalidad fetal materna no despreciable, realizar un manejo efectivo resulta de gran importancia. Se han propuesto y seguido varias técnicas de manejo a nivel mundial con evidencia variable sobre la eficacia de dichos tratamientos, sin embargo, aún no se ha descubierto una técnica de manejo óptima. Presentamos el caso de una paciente con 4 partos previos de 24 años de edad con historial obstétrico extenso que incluye distocia de hombros, hemorragia posparto y praevia placentaria previa. En su embarazo actual, se realiza un diagnóstico de placenta previa acreta con evidencia de invasión cervical y la paciente se maneja con éxito con el novedoso tratamiento quirúrgico conservador denominado “Triple P”.

  • English

    Placenta accreta is an abnormal invasion of the placenta into the uterine myometruim that carries a significant obstetric risk including major post-partum haemorrhages. Unfortunately, this incidence of this condition is on a rise and appears to be linked to the increase in invasive surgical procedures such as caesarean sections, myomectomies and uterine dilatation and curettage, amongst many others. It is in the best interest of women to agree on the most effective management, as it is significantly associated with a non-negligible maternal foetal morbidity and mortality and its incidence is set to increase further. Several management techniques have been proposed and trailed globally with variable evidence on the efficacy of said treatments and variable patient outcomes, yet an optimal management technique is yet to be discovered. We report the case of a 24 year old Gravid 5 Para 4 with a previous history of gestational diabetes, the patients BMI and extensive obstetric history including a shoulder dystocia, Post-Partum haemorrhage and previous placental praevia. In her current pregnancy, a diagnosis of placenta praevia and placenta accreta with evidence of cervical invasion is made and the patient is successfully managed with the novel conservative management surgical ‘Triple P’ procedure.