Abstract book 6th RMS 16.indd

publication by NICE and use in the National
Health Service in England and Wales. The
guidelines are based on evidence of clinical
and cost effectiveness.
This guideline was published in 2010
The Key Recommendations based on the
best evidence cover the following topics/
areas:
1. Measures to reduce the risk of hypertensive
disorders in pregnancy
2. Management of pregnancy with chronic
hypertension
3. Assessment of proteinuria in hypertensive
disorders of pregnancy
4. Management of pregnancy with gestational
hypertension
5. Management of pregnancy with preeclampsia
6. Advice and follow-up care at transfer to
community care
143
Modern management of PPH
Zarko Alfirevic MD (UK)
The lecture will focus on recent clinical
trials of various treatment strategies for the
management of PPH including misoprostol
and tranexamic acid. The data from the
recently updated Cochrane review will
be presented, together with the recently
updated FIGO guideline for the use of
misoprostol for PPH.
144
Surgical Management of Placenta
Accreta: A Three Years Experience at
King Hussein Medical Center
Maher Maaita MD FRCOG*, Vera Amarin MD,
JBOG, Njood abotaleb MD, JBOG
* Consultant Obstetrician and Gynaecologist,
Royal Medical Services (Jordan)
mmaaita@hotmail.com
Objectives: The purpose of this study
was to report our experience for surgical
management of suspected placenta
accreta.
Methods: This was a retrospective study
of all patients who underwent planned
hysterectomy for placenta accreta at
KHMC from august 2009 to October 2011.
Results: Thirty two patients were
identified. Diagnosis was suspected
on ultrasound scanning in 23 women
(6 women also underwent Magnetic
resonance imaging) and on 9 women
during elective caesarean delivery for
placenta previa. In those women (23) who
was diagnosed antenatal by ultrasound
and MRI underwent cesarean delivery and
hysterectomy without attempt of removal of
placenta, on 9 women who was diagnosed
during C/S were managed initially with
Bakery balloon (3 cases), postoperative
hemorrhage occurred required reoperation
and hysterectomy. Haemostatic stitches,
(2cases), 4 cases developed PPH after
separation of placenta and all underwent
hysterectomy. One case was assessed with
interventional radiologist with placement
of balloon catheters into the common
iliac arteries bilaterally, and inflation the
balloon catheters after the delivery of
fetus. All of the women were multiparious,
with previous more than two cesarean
section deliveries. Twenty seven women
had a placenta previa, and 5 women had
a low anterior placenta. Final pathologic
findings revealed accreta (27), increta (4),
and percreta (1). Two women had ureteral
injury, 8 women had cystotomy, and 1
woman had with vesicovaginal fistula.
Conclusion: Placenta accrete
remains a high-risk obstetric condition,
adequate preoperative planning with a
multidisciplinary team is recommended to
reduce the complications associated with
placenta accreta
145
Prophylactic Balloon Occlusion of
the Common Iliac Artery in a Patient
with Complete Placenta Previa
and Accrete: New Approach to
Bleeding Control during Cesarean
Hysterectomy, Case Report at King
Hussein Medical Center
Vera Amarin MD*, Dr. Maher Maaita, Dr
Hazem Haboob
Consultant Obstetrics and gynecology, Subspecialist
in Fetal Medicine, Royal Medical Services
(Jordan)
baceel@hotmail.com
Objectives: Placenta accreta, is an important
condition with significant problems at
delivery because of incomplete placental
separation, hemorrhage, neonatal death,
infection, fistula formation, ureteral
damage, and bladder injury.
91 www.jrms.gov.jo