Triple P with T-shaped lower segment suture; an effective novel alternative to hysterectomy in morbidly adherent anterior placenta previa

Purpose: To evaluate the efficacy and safety of the Triple-P procedure as a conservative method in women with morbidly adherent placenta (MAP). Materials and methods: A prospective trial conducted on 20 women performing elective cesarean sections (CS) at 37?weeks for anterior placenta previa accreta or increta. All women were young aged with low parity and previous CS deliveries. Triple-P procedure involved delivery of the fetus through a uterine incision placed above the upper border of the placenta, bilateral uterine arteries ligation immediately after delivery of the fetus followed by placental nonseparation and myometrial excision with reconstruction of the uterine wall in a T-shaped manner. The study outcome measures included duration of surgery, amount of intra and postoperative blood loss, Percentage of hemoglobin (Hb %) reduction, the need to perform hysterectomy and postoperative complications. Results: Mean duration of surgery was 58???1.8?min, mean intraoperative blood loss was 1.3???0.3?l, mean postoperative blood loss was 180???94?ml and mean Hb % reduction was 1.5???0.1?g/dl. Only one case necessitated hysterectomy for severe bleeding. Conclusion: Triple-P procedure is a novel effective weapon that can replace hysterectomy in suitable women with MAP, especially in young patients with low parity.

Automated summary

The Triple-P procedure is an effective conservative treatment for women with morbidly adherent placenta (MAP), particularly in young patients with low parity. The procedure significantly reduces operative time and blood loss, with only a small number of cases requiring hysterectomy.