Abstract
Objective:
Placenta accreta is an abnormal implantation of the placenta, which often leads to postpartum bleeding. Cesarean hysterectomy is the most recommended procedure. However, more-conservative management is currently being investigated to maintain future fertility or uterus. This study was designed to describe a new systematic surgical technique for preserving the uterus while removing the abnormal placenta. Additional goals were to determine the characteristics and outcomes of this procedure.
Materials and Methods:
This approach involved corporal incision, hypogastric artery ligation, and using an ovarian and pericervical uterine tourniquet. Fifty-nine patients were enrolled in this cross-sectional study, with a median age of 29, ranging from ages 25 to 37. Eighteen of these patients (30.5%) were in their second pregnancy and had only 1 previous childbirth, 38 patients (64.4%) were in their third pregnancy, and 3 (5.1%) were in their forth pregnancy.
Results:
All patients had successful uterine preservation after the removal of their abnormal placentae. Median bleeding volume was 550 (range: 300–1200) mL. Bladder injury occurred in 1 patient.
Conclusions:
Using this systematic surgical technique and temporarily devascularizing the patients' uteri, it was possible to remove the abnormal placentae—without incurring massive bleeding—and then to reconstruct the uteri.
Get full access to this article
View all access options for this article.