Myometrial Resection versus Caesarean Section Hysterectomy in Patients with Morbidly Adherent Placenta

Abstract

Objective: To observe the comparative outcome of cesarean hysterectomy versus myometrial resection among patients of morbid adherent placenta in terms of post-operative complications at tertiary care Hospital.

Methodology: This comparative study was conducted in the gynecology department of Isra university hospital over periods of 2 years from Jan 2016 to December 2018. Total 70 patients presented with morbid adherent placenta were included, followed by 25 patients were taken in group A, who underwent cesarean hysterectomy while 45 patients were taken in group B who had myometrial resection. All the information regarding mode of surgery i.e., elective or emergency, booking status, blood loss, need of placement of additional compression sutures, post operative hospital stay, need of blood transfusion, morbidity was recorded on self-designed proforma. Dara analysis was done by SPSS version 20.

Results: Total 70 patients were studied; their mean age was 37.23+5.12 years. Majority of patients 14(56%) had emergency cesarean hysterectomy while in local resection group 32 (71.11%) had emergency surgery. Most of the females were un-booked in both groups. Estimated average of blood loss was 4±1.0 units in group A, while in group B it was 2±1.0 units. Post operative infection was seen in 11(45%) patients of group A, while 9(17.78%) was in group B. Bladder injury was also higher 6 (24%) in group A in contrast to group B as 4(8.88%). Blood loss of >2000 ml was 11(45%) in patients of group A while 8(16.66%) in group B. Re-laparotomy rate was significantly lower 4(16%) in group A compared to group B 2(4.44%) (p-0.001).

Conclusion: The myometrial resection was observed to be the effective, safe and reliable technique with less post operative complications including post-operative infection, less blood loss, lower risk of the bladder injury and lower rate of relaparotomies as compared to cesarean hysterectomy.