UNAIR NEWS – Maternal mortality due to placenta accreta continues to grow. It is a condition in which the placental blood vessels or other parts of the placenta grow too deep into the uterine wall and even out of the uterus.

Data compiled by Dr. Soetomo General Hospital stated that the high number of placenta accreta always increases every year. There were 7 incidents in 2015, 27 incidents in 2016, 60 incidents in 2017, and 71 incidents in 2018. Placenta accreta is one of the serious problems of pregnancy because it could endanger the lives of the mothers.

A lecturer and a doctor of FK UNAIR-Dr. Soetomo, Dr. Rozi Aditya Aryananda, SpOG., has handled and performed surgeries with the most cases of placenta accreta. It is not only in the scope of Indonesia, but also in Asia. The problem is, why is there an explosion of placenta accrete cases, especially in the city of Surabaya?

Dr. Rozi said that the case was rarely found at first. In 2013, there was only one case, and then it increased year by year. Until now, references on placenta accreta cases are quite controversial. The emergence of this incident, he said, has changed the medical concepts believed by doctors in the Obstetrics and Gynecology field.

Placenta accreta is life-threatening because in its occurrence it can deplete the blood of pregnant women to liters. Normally, pregnancy surgery consumes blood from 500cc to 1 liter. In the case of placenta accreta, the mother can lose a lot more blood.

A placenta accreta surgery handled by doctor Rozi’s team (the placenta accreta team) in Dr. Soetomo General Hospital, spent up to 21 liters of blood when the human body only holds about 6 liters of blood.

Minimizing bleeding

Regarding the surgery, doctor Rozi looked at a different approach. Since he met a professor of Anatomy from Argentina in 2016, he continued to study cases and study anatomy in depth. Together with the professor, Rozi then tried to do an operation with a different approach. The result is quite promising.

“For the bleeding that usually consumes liters of blood, we could reduce it to only 1 liter,” said doctor Rozi.

In the new approach, the placenta accreta team performed surgery by first searching for blood vessels one by one and conducting observation. So, during placenta extraction, the blood vessels are all under control.

“In this case (the placenta accreta, ed) the concept of surgery which has always been used can be very dangerous. Many new blood vessels are formed due to placenta accreta and are very difficult to overcome if a bleeding happened. Imagine the blood coming out like water coming out of a hose, “he explained, explaining the danger of placenta accreta.

The placenta accreta case, said Rozi, caused high mortality rate due to uncontrolled bleeding. He and the team tried to approach the surgery to minimize bleeding.

In addition to surgical techniques, Rozi and the team also developed the latest diagnostic technique that predicts to the extent where the placenta will come out.

“This diagnostic technique can predict a dangerous surgery,” he explained.

So, who is likely to experience placenta accreta?

From various observations made by Rozi, the obtained data showed that placenta accreta occurs mostly in mothers who have had a maternity surgery. All this time the baby’s labor surgery has long been carried out as a method of removing the baby from the uterus. So, why did the placenta accreta happen only recently?

He and his team are now looking for answers to this. During the placenta accreta surgery, he usually collaborated with many medical specialists such as pediatricians, vascular surgeons, urologists, gynecologist, oncologists, clinical pathologists, anatomical pathologists, anesthesiologists and other specialists related to labor surgery.

Rozi was named the doctor who handled the most cases of placenta accreta. In the city of Surabaya, he had carried out surgeries about 200 times. Because of the method he developed, he was invited to present his ideas in various countries such as in Hong Kong (2017); Malaysia, Australia, Netherlands (2018); and February 2019 in Singapore.

“Most of them were shocked because in their country there are not as many cases as in Indonesia, especially in the city of Surabaya,” he explained.

For him, the success of a doctor’s work is caused by the success of team work, not individual work. So, there is a motto that Rozi’s teachers have always instilled in Rozi’s mind until now, “There is no best doctor, but the best team “. (*)

Author: Binti Q. Masruroh