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PICO

Patients/Problem/ - This is a retrospective case–control study of all women diagnosed with morbidly
Population adherent placenta who underwent either planned or urgent cesarean
hysterectomy between January 1, 2011, and February 30, 2017 (tidak disebutkan
secara jelas/spesifik jumlah pasien yang diteliti).
- Patients was identified from clinical rosters maintained by the Maternal-Fetal
Surgery Section at the Department of Obstetrics and Gynecology, Baylor College
of Medicine–Texas Children’s Hospital Pavilion for Women.

Intervension - Pada jurnal ini merupakan jurnal yang menggunakan metode cohort, metode ini
merupakan jenis yang kuat setelah tipe RCT.
- Patients are generally admitted several days before planned cesarean
hysterectomy at 34–35 weeks of gestation to stabilize existing comorbid medical
conditions, administer corticosteroids for fetal lung maturation
- In brief, the surgical approach utilized to manage the operative delivery of
patients with morbidly adherent placenta includes cystoscopy under anesthesia
with placement of bilateral ureteral catheters anchored to a 20-French indwelling
urethral balloon catheter (prosedur SC dilakukan)
Comparison women who underwent cesarean hysterectomy at their planned
date and those who underwent earlier urgent cesarean hysterectomy

Outcome - In this study, we tested our hypothesis that women who undergo cesarean
hysterectomy for morbidly adherent placenta urgently are at increased risk
for composite morbidity when compared with those who undergo this
surgery as a scheduled procedure.
- In conclusion, our findings suggest urgent delivery of women with morbidly
adherent placenta is associated with worse outcomes than women with
planned delivery even when managed by a dedicated multidisciplinary team.
This worse outcome is primarily the result of increased rates of maternal
coagulopathy and the need for more aggressive blood transfusion when the
surgery is precipitated by vaginal bleeding as well as increased neonatal
morbidity.