Resective-reconstructive Treatment of Abnormally Invasive Placenta: Inter Institutional Collaboration by Telemedicine (eHealth)

J Matern Fetal Neonatal Med. 2019 May 27;1-9. doi: 10.1080/14767058.2019.1615877. Online ahead of print.

Abstract

Introduction: Resective-reconstructive treatment of an abnormally invasive placenta, also known as conservative surgical management, allows a comprehensive treatment of the pathology in only one surgery; however, this alternative is not generally included in international consensus, as it requires specific training. Here, we report our experience of this type of treatment and its plausibility after training facilitated by interinstitutional collaboration via telemedicine. Materials and methods: A total of 48 women who were diagnosed with abnormally invasive placenta, before and after changes due to the resection-reconstruction protocol were included in the study. Results: In total, 14 conservative reconstructive procedures were performed with outcomes of a lower rate of bleeding, reduced transfusions and complications, and a shorter duration of hospitalization than women with hysterectomy. Conclusion: Conservative surgical management is a safe alternative when implemented at specialized centers by trained groups of professionals. Interinstitutional collaboration, using appropriate telemedicine is a safe and effective alternative to enable training in resective-conservative management of abnormally invasive placenta.

Keywords: Conservative treatment; maternal outcomes; multidisciplinary team; placenta accreta; surgical procedure.