Results of prevention and current treatment of massive obstetric hemorrhage secondary to uterine atony and placenta accreta

Objective: To evaluate current morbidity and mortality in patients with uterine atony and placenta accreta, using various treatments introduced in recent years in a single institution. Materials and methods: A retrospective analysis was conducted in 143 pregnant women with uterine atony (n = 70) and placenta accreta (n = 73) admitted to the intensive care division from March 1991 to February 2008. Results: Fifty-five patients (38.4%) had hemorrhagic shock and 47 (32.8%) had coagulation factor defects. The mean red cell transfusion requirement was 4.7 4.2 units. Sixty-six patients underwent hysterectomy as the last choice to stop massive bleeding. From 2002, several novel surgical techniques were used: uterine compression sutures (n = 18), uterine artery ligations (n = 15) and surgical uterine repair in patients with placenta percreta (n = 17). In 31 patients, embolization of the uterine arteries was performed as treatment and prevention of massive hemorrhage, reducing morbidity and significantly increasing uterine conservation. All 143 puerperal women survived without sequelae. Conclusions: Incorporation of new surgical techniques and embolization of the uterine arteries was associated with a significant decrease in the prevalence of hysterectomies, lower postoperative morbidity and optimal maternal survival. (C) 2008 Elsevier Espana, S.L. All rights reserved.