{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T03:19:56Z","timestamp":1783999196501,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T00:00:00Z","timestamp":1648598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The distinguished Triple-P procedure has been reported as a conservative surgical alternative to peripartum hysterectomy for placental accreta spectrum (PAS). In this study, we modified the procedure combined with prophylactic abdominal aorta balloon occlusion and\/or tourniquet and evaluated the effect and long-term outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study involving pregnant patients with clinically confirmed severe PAS (including placenta increta and percreta) between January 1st, 2017 and June 30th, 2020 in the First Affiliated Hospital of Zhengzhou University. A total of 334 pregnant women were recruited in this study. The 142 women that were subjected to modified Triple P Procedure were regarded as the observation group while 194 pregnant women that were treated with other sutures were regarded as the control group. Demographic characteristics, placental accreta spectrum score (PAS score), estimated blood loss (EBL), operative time, blood transfusion rate and volume, neonatal weight, post-operative hospital stays and costs were evaluated. Short-term complications, including fever, hematoma, thrombus, bladder rupture and intensive care unit (ICU) transfer rate, as well as long-term outcomes including breast feeding, menstruation, intrauterine adhesion, and chronic abdominal pain among others were followed up in the outpatient clinic and by phone calls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For all cases, EBL was lower in the observation group than in the control group, 1,200 (687\u20131,812) ml and 1,300 (800\u20132,500) ml, respectively. The difference was statistically significant (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). Operative time were statistically significantly shorter in the observation group [99.5 (84.0\u2013120.0) min and 109.0 (83.8\u2013143.0) min, <jats:italic>P<\/jats:italic> &amp;lt; 0.05]. Lengths of postoperative hospital stays were 4 (4\u20137) and 5 (4\u20137) days in the observation and control group, which was significantly shorter in the observation group (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). There were no significant differences in PAS scores, blood transfusion volume, neonatal weight, fever, hematoma, thrombus, bladder rupture and ICU transfer rates between the two groups. All patients, except one in control group, had preserved uterus. There were no statistically significant differences in short-term and long-term complications between two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In summary, when combined with tourniquet and\/or prophylactic abdominal aorta balloon occlusion, modified Triple-P procedure may be effective in reducing intraoperative blood loss and hysterectomy in patients with placenta increta\/percreta. It is a safe and effective surgical alternative to peripartum hysterectomy. However, the complications associated with interventional radiology service should be evaluated furthermore.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.839716","type":"journal-article","created":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T14:03:59Z","timestamp":1648649039000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Effects and Long-Term Outcomes of a Modified Triple-P Procedure in Patients With Severe PAS: A Retrospective Cohort Study"],"prefix":"10.3389","volume":"9","author":[{"given":"Huidan","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianlan","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya","family":"Tao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruixia","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1002\/ijgo.12406","article-title":"FIGO consensus guidelines on placenta accreta spectrum disorders: introduction","volume":"140","author":"Jauniaux","year":"2018","journal-title":"Int J Gynaecol Obstet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1111\/1471-0528.15306","article-title":"Placenta praevia and placenta accreta: diagnosis and management: green-top guideline no","volume":"126","author":"Jauniaux","year":"2019","journal-title":"BJOG."},{"key":"B3","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.ejogrb.2020.01.047","article-title":"Hysterectomy and sexual (dys)function: an analysis of sexual dysfunction after hysterectomy and a search for predictive factors","volume":"247","author":"Dedden","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.ejogrb.2016.01.008","article-title":"Effect of simple and radical hysterectomy on quality of life - analysis of all aspects of pelvic floor dysfunction","volume":"198","author":"Selcuk","year":"2016","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/j.ijgo.2011.12.005","article-title":"The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta","volume":"117","author":"Chandraharan","year":"2012","journal-title":"Int J Gynaecol Obstet."},{"key":"B6","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1111\/j.1471-0528.1997.tb11471.x","article-title":"The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported","volume":"104","author":"C","year":"1997","journal-title":"Br J Obstet Gynaecol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1097\/00006250-200007000-00026","article-title":"Hemostatic suturing technique for uterine bleeding during cesarean delivery","volume":"96","author":"Cho","year":"2000","journal-title":"Obstet Gynecol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1097\/00006250-200203000-00022","article-title":"Uterine compression sutures: surgical management of postpartum hemorrhage","volume":"99","author":"Hayman","year":"2002","journal-title":"Obstet Gynecol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1420","DOI":"10.1111\/j.1471-0528.2005.00666.x","article-title":"Parallel vertical compression sutures: a technique to control bleeding from placenta praevia or accreta during caesarean section","volume":"112","author":"Hwu","year":"2005","journal-title":"BJOG."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1111\/1471-0528.13685","article-title":"Funnel compression suture: a conservative procedure to control postpartum bleeding from the lower uterine segment","volume":"123","author":"Li","year":"2016","journal-title":"BJOG."},{"key":"B11","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1111\/1471-0528.15410","article-title":"'Nausicaa' compression suture: a simple and effective alternative to hysterectomy in placenta accreta spectrum and other causes of severe postpartum haemorrhage","volume":"126","author":"Shih","year":"2019","journal-title":"BJOG."},{"key":"B12","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1002\/ijgo.12761","article-title":"FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders","volume":"146","author":"Jauniaux","year":"2019","journal-title":"Int J Gynaecol Obstet."},{"key":"B13","doi-asserted-by":"publisher","first-page":"68","DOI":"10.3760\/cma.j.cn112141-20200606-00478","article-title":"Effect of radial modified figure of eight suture around cervix in patients with placenta percreta","volume":"56","author":"Zhao","year":"2021","journal-title":"Chin J Obstetrics Gynecol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"705","DOI":"10.3760\/cma.j.issn.1007-9408.2016.09.014","article-title":"Value of ultrasonic scoring system for predicting risks of placenta accreta","volume":"19","author":"Zhong","year":"2021","journal-title":"Chin J Perinatal Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1002\/ijgo.12990","article-title":"Outcomes of the first 50 patients with abnormally invasive placenta managed using the \u201cTriple P Procedure\u201d conservative surgical approach","volume":"148","author":"Pinas-Carrillo","year":"2020","journal-title":"Int J Gynaecol Obstet."},{"key":"B16","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.bpobgyn.2020.07.009","article-title":"Conservative surgical approach: the Triple P procedure","volume":"72","author":"Pinas-Carrillo","year":"2021","journal-title":"Best Pract Res Clin Obstet Gynaecol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1002\/uog.14728","article-title":"Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure","volume":"46","author":"Teixidor Vinas","year":"2015","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1007\/s00404-017-4447-0","article-title":"Evaluation of a modified \u201cTriple-P\u201d procedure in women with morbidly adherent placenta after previous caesarean section","volume":"296","author":"Wei","year":"2017","journal-title":"Arch Gynecol Obstet."},{"key":"B19","doi-asserted-by":"publisher","first-page":"3187","DOI":"10.1080\/14767058.2019.1678145","article-title":"Triple P with T-shaped lower segment suture; an effective novel alternative to hysterectomy in morbidly adherent anterior placenta previa","volume":"34","author":"Abo-Elroose","year":"2021","journal-title":"J Matern Fetal Neonatal Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.ijoa.2015.12.001","article-title":"Prophylactic abdominal aorta balloon occlusion during caesarean section: a retrospective case series","volume":"27","author":"Wei","year":"2016","journal-title":"Int J Obstet Anesth."},{"key":"B21","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1080\/01443615.2017.1291588","article-title":"Prophylactic use of an infrarenal abdominal aorta balloon catheter in pregnancies complicated by placenta accreta","volume":"37","author":"Xie","year":"2017","journal-title":"J Obstet Gynaecol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1016\/j.crad.2015.03.008","article-title":"Caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation for the management of placenta accreta","volume":"70","author":"Duan","year":"2015","journal-title":"Clin Radiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.1007\/s00270-016-1418-y","article-title":"Outcome of pregnancies after balloon occlusion of the infrarenal abdominal aorta during caesarean in 230 patients with placenta praevia accreta","volume":"39","author":"Wu","year":"2016","journal-title":"Cardiovasc Intervent Radiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1024\/0301-1526\/a000577","article-title":"Comparison of temporary abdominal aortic occlusion with internal iliac artery occlusion for patients with placenta accreta - a non-randomised prospective study","volume":"46","author":"Wang","year":"2017","journal-title":"Vasa."},{"key":"B25","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s12884-019-2175-0","article-title":"Clinical evaluation of prophylactic abdominal aortic balloon occlusion in patients with placenta accreta: a systematic review and meta-analysis","volume":"19","author":"Chen","year":"2019","journal-title":"BMC Pregnancy Childbirth."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e8114","DOI":"10.1097\/MD.0000000000008114","article-title":"Preoperative infrarenal abdominal aorta balloon catheter occlusion combined with Bakri tamponade reduced maternal morbidity of placenta increta\/percreta","volume":"96","author":"Zeng","year":"2017","journal-title":"Medicine."},{"key":"B27","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/j.1447-0756.2005.00247.x","article-title":"Tourniquet technique prevents profuse blood loss in placenta accreta cesarean section","volume":"31","author":"Ikeda","year":"2005","journal-title":"J Obstet Gynaecol Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1002\/ijgo.12199","article-title":"Two-tourniquet sequential blocking as a simple intervention for hemorrhage during cesarean delivery for placenta previa accreta","volume":"138","author":"Meng","year":"2017","journal-title":"Int J Gynaecol Obstet."},{"key":"B29","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1007\/s00270-011-0166-2","article-title":"Perioperative temporary occlusion of the internal iliac arteries as prophylaxis in cesarean section at risk of hemorrhage in placenta accreta","volume":"34","author":"Carnevale","year":"2011","journal-title":"Cardiovasc Intervent Radiol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1007\/s00404-014-3436-9","article-title":"Prophylactic balloon occlusion of the common iliac arteries for the management of suspected placenta accreta\/percreta: conclusions from a short case series","volume":"291","author":"Minas","year":"2015","journal-title":"Arch Gynecol Obstet."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1756","DOI":"10.1016\/j.ajog.2005.08.033","article-title":"Temporary balloon occlusion of the common iliac artery: new approach to bleeding control during cesarean hysterectomy for placenta percreta","volume":"193","author":"Shih","year":"2005","journal-title":"Am J Obstet Gynecol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1111\/j.1471-0528.2009.02217.x","article-title":"Thromboembolism of the leg following prophylactic balloon occlusion of the uterine arteries","volume":"116","author":"Chouliaras","year":"2009","journal-title":"BJOG."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1007\/s12630-013-0038-0","article-title":"Iliac artery rupture related to balloon insertion for placenta accreta causing maternal hemorrhage and neonatal compromise","volume":"60","author":"Gagnon","year":"2013","journal-title":"Can J Anaesth."},{"key":"B34","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.ijoa.2010.09.012","article-title":"Multiple complications following the use of prophylactic internal iliac artery balloon catheterisation in a patient with placenta percreta","volume":"20","author":"Bishop","year":"2011","journal-title":"Int J Obstet Anesth."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.839716\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T14:04:02Z","timestamp":1648649042000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.839716\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,30]]},"references-count":34,"alternative-id":["10.3389\/fmed.2022.839716"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.839716","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,30]]},"article-number":"839716"}}