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Efficacy (In Terms of Avoiding Hysterectomy) of the Triple P Procedure in Managing Morbidly Adherent Placenta


Article Information

Title: Efficacy (In Terms of Avoiding Hysterectomy) of the Triple P Procedure in Managing Morbidly Adherent Placenta

Authors: Sadaf Mumtaz, Nighat Afridi, Salma Nisar, Hira Shafqat, Waseem Yousaf, Nafeesa Hiba

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History
Category From To
Y 2024-10-01 2025-12-31
Y 2023-07-01 2024-09-30
Y 2021-07-01 2022-06-30
Y 2020-07-01 2021-06-30
Y 1900-01-01 2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2023

Volume: 73

Issue: 6

Language: English

Keywords: HysterectomyMorbidly adherent placentaTriple P procedure

Categories

Abstract

Objective: To determine the efficacy (in terms of avoiding hysterectomy) of the Triple P procedure in managing morbidly adherent placenta.
Study Design: Case series.
Place and Duration of the Study: Department of Obstetrics & Gynaecology, Combined Military Hospital, Peshawar Pakistan, from Dec 2018 to Mar 2020.
Methodology: A total of 56 pregnant women of gestational age ≥32 weeks with the morbidly adherent placenta were included. Caesarean section was done in each patient by the consultant gynaecologist, and then the Triple P procedure was done. Efficacy in each patient was noted.
Results: The mean age of the study participants was 30.79±4.42 years. In our analysis, the mean parity was 3.05±0.88. The mean number of caesarean sections was 2.00±1.11. The Triple P procedure was effective (in avoiding hysterectomy) in managing morbidly adherent placentas in 53(94.64 %) participants.
Conclusion: This study concluded that the Triple P procedure's efficacy (in terms of avoiding hysterectomy) in managing morbidly adherent placenta is very high.


Research Objective

To determine the efficacy (in terms of avoiding hysterectomy) of the Triple P procedure in managing morbidly adherent placenta.


Methodology

Case series conducted at Combined Military Hospital, Peshawar, Pakistan, from December 2018 to March 2020. 56 pregnant women with morbidly adherent placenta (gestational age ≥ 32 weeks) were included. The Triple P procedure (perioperative placental localization and delivery of the fetus via transverse uterine incision above the upper border of the placenta; devascularization of the uterus by ligation of both internal iliac arteries and placental non-separation with myometrial excision and reconstruction of the uterus) was performed after caesarean section. Efficacy was noted in terms of avoiding hysterectomy.

Methodology Flowchart
                        graph TD;
    A["Identify Pregnant Women with Morbidly Adherent Placenta Gestational Age >= 32 weeks"] --> B["Obtain Informed Consent"];
    B --> C["Perform Caesarean Section"];
    C --> D["Perform Triple P Procedure"];
    D --> E["Note Efficacy in Avoiding Hysterectomy"];
    E --> F["Record Patient Data Age, Gestational Age, Parity, etc."];
    F --> G["Analyze Data using SPSS"];
    G --> H["Draw Conclusions"];                    

Discussion

The study concludes that the Triple P procedure has a very high efficacy in managing morbidly adherent placenta and avoiding hysterectomy. This less invasive surgical option is recommended to reduce maternal complications and mortality associated with severe hemorrhage. The procedure involves placental localization, fetal delivery via an incision above the placenta, pelvic devascularization, and myometrial excision.


Key Findings

The Triple P procedure was effective in avoiding hysterectomy in 53 out of 56 participants, resulting in an efficacy of 94.64%. The mean age of participants was 30.79±4.42 years, mean parity was 3.05±0.88, and the mean number of previous caesarean sections was 2.00±1.11.


Conclusion

The Triple P procedure demonstrates high efficacy in managing morbidly adherent placenta and avoiding hysterectomy. It is recommended as a primary approach to reduce maternal complications and mortality, allowing for fertility preservation.


Fact Check

1. Efficacy Rate: The study reports a 94.64% efficacy rate for the Triple P procedure in avoiding hysterectomy (53 out of 56 patients).
2. Study Duration: The study was conducted from December 2018 to March 2020.
3. Sample Size: A total of 56 pregnant women were included in the study.


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