Local resection for placenta accreta spectrum: a conservative uterus sparing technique for anterior placenta accreta

Gülsüm Uysal, Nefise Tanrıdan Okçu, Eda Eskimez, Esra Saygılı Yılmaz
2018 The European Research Journal  
Objectives: To evaluate and describe a surgical approach for uterine preservation and management of postpartum hemorrhage in placenta accreta spectrum (PAS). Methods: We analyzed the data of patients who were diagnosed with placenta previa companied with PAS prenatally and subsequently performed cesarean section with local resection technique to manage postpartum hemorrhage and uterine preservation at our tertiary care center between January 2016 and August 2017. The technique includes the
more » ... resection of placental invasion site and suturing the new uterine edges without internal iliac artery ligation. Results: The diagnosis of placenta accreta spectrum anterior in all 11 cases was confirmed intraoperatively. Only 1 case underwent hysterectomy in a second operation. Two of cases had bladder injury. The mean operative time was 99 ± 30 minutes. The mean received packed red blood cells was 2.3 ± 1.0 units. The mean length of postoperative hospital stay was 4.5 ± 1.4 days. There was no late complications regarding coagulopathy and infection. No maternal mortality was observed. Conclusion: Local resection is an effective, safe and fertility preserving approach in selected patients with PAS. The European Research Journal 2019;5(1):50-57 lacenta accreta spectrum (PAS) disorders, comprise the spectrum of adhesive plasental invasions formerly called placenta accreta, increta, percreta [1] [2] [3] . PAS refers to an abnormal implantation of anchoring placental vili to myometrium, uterine serosa or adjacent organs instead of staying limited to decidua [2, 3] . Major risk factors include placenta previa andprevious cesarean deliveries. Other risk factors are prioruterine scars (myomectomy, infertility treatments, cornual resection of ectopic pregnancy, hysteroscopic septum resections or removal of uterine adhesions), recurrent abortions, dilatation and curettage (D/C), smoking, advanced maternal age and parity [2] [3] [4] . PAS became an important life-threatening obstetric problem sincefrequency of ithas been risingconstantly in recent decades due to increasing rates of caesarean deliveries. Moreover, adherent placenta has been replacing withuterine atony as major cause of cesarean hysterectomy [4, 5] . Antenatal diagnosis, and planned preterm cesarean hysterectomy (between 34-35 weeks gestation) with the placenta left in situ is the recommended treatment P
doi:10.18621/eurj.382390 fatcat:lxpyf5erejdtjmfo775zc3u6ym