PLACENTAL ACCRETISM

CESAREAN - HISTERECTOMY A SERIES OF CASES

Abstract

Introduction: Acretism is the implantation of the abnormal placenta in the uterine wall, it is classified according to the degree of depth. The incidence Introduction: Acretism is the implantation of the abnormal placenta in the uterine wall, it is classified according to the degree of depth. The incidence of accretion increased worldwide in parallel with the increase in cesarean sections, with 1 case for every 533 births. Objective: To evaluate cesarean surgery / hysterectomy (placenta in loco) as a healthy maternal-fetal binomial resolution. Method: case series. Discussion: The best therapeutic proposal in cases of accretism is the planning of cesarean delivery followed by total abdominal hysterectomy (THA). Conservative treatment (maintenance of the uterus leaving the placenta in situ) due to the associated high morbidity and mortality should be considered exceptionally. The patient profiles of the cases fit the risk factors mentioned in the studies. All cases had previous cesarean section and diagnosis of placenta previa; average age: 36.8 years (32-41 years); average parity (gestation): 2.8 (G4-G2). Thus, we are going to meet what the literature cites as the main risk factors. Case 2 was scheduled for cesarean delivery and hypertension. However, during cesarean section, the uterus was preserved and evolved to hemorrhagic shock 4 hours after the end of the procedure, requiring THA in the 2nd period. In cases 1, 3 and 4, cesarean delivery and hypertension were planned without complications. In all cases, the final treatment evolved with hysterectomy, meeting the literature as the best therapy. Final considerations: Good conduct in the face of accretism with prior diagnosis through USG and Doppler, delivery planning in a referral center (reserve of hemoconcentrates and ICU) with an experienced and multidisciplinary team has the power to change the prognosis.