DefinePK

Research Objective

To determine the frequency of hysterectomy in morbidly adherent placenta in post-cesarean section patients.

Methodology

A hospital-based cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from September 2019 to April 2020. A total of 210 participants were selected using the WHO calculator with a 95% confidence interval, an anticipated proportion of 7%, and a required absolute proportion of 3.5%. Inclusion criteria included reproductive-age women (18-42 years) with parity 1-3, confirmed pregnancy by ultrasound between 36-42 weeks, a singleton fetus, and a history of previous Cesarean section. Exclusion criteria included placenta abruption, primigravida, history of PID, D&C, IUCD insertion, or patient unwillingness. Doppler ultrasound was used for MAP detection, and data was collected via a pre-designed Performa. Data was analyzed using SPSS version 21.

Methodology Flowchart

                        graph TD
    A["Recruit Participants 18-42 yrs, history of C-section"] --> B["Confirm Pregnancy & Gestation"36-42 wks""];
    B --> C["Perform Doppler Ultrasound for MAP Detection"];
    C --> D["Collect Data via Performa"Demographics, MAP Type, Procedure""];
    D --> E["Data Entry into SPSS v21"];
    E --> F["Data Analysis Descriptive Statistics, Frequencies"];
    F --> G["Report Findings Hysterectomy Frequency, Complications"];                    

Discussion

The study highlights a high frequency of hysterectomy for MAP in post-Cesarean section patients, suggesting it is a primary management strategy to protect maternal life. The findings align with other studies emphasizing hysterectomy for successful MAP management. The study also notes that all participants had a history of Cesarean section, a known risk factor for MAP. While hemorrhage is a significant complication, early diagnosis and quality care contributed to zero mortality in this study. The need for further research into conservative methods to preserve fertility is also emphasized.

Key Findings

The frequency of hysterectomy in morbidly adherent placenta (MAP) in post-Cesarean section women was 79.04% (n=166). Of the remaining 44 patients, 10% underwent Triple-P, 7.14% had B-Lynch, and 3.8% had Balloon Tamponade. The most common complication was bleeding (78.6%), requiring massive blood transfusion. No mortality was reported.

Conclusion

A large proportion of MAP cases are managed by hysterectomy, particularly in low-middle income countries like Pakistan. Further research is required on conservative methods for managing MAP to protect fertility.

Fact Check

1. Hysterectomy Frequency: The study reported a hysterectomy frequency of 79.04% (n=166) in morbidly adherent placenta cases among post-Cesarean section patients.
2. Study Duration: The study was conducted over an 8-month period from September 2019 to April 2020.
3. Total Participants: A total of 210 participants were selected for the study.

Mind Map