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Conservative stepwise surgical approach for management of placenta previa accrete

Mahmoud Mohammed Ghaleb

Conservative stepwise surgical approach for management of placenta previa accrete describes a stepwise surgical approach for conservative management of placenta previa accreta to preserve women’s uterus and to evaluate the efficacy and safety of this approach in controlling postpartum hemorrhage associated with conservative management. A prospective case series study conducted on 62 pregnant women with one or more cesarean deliveries diagnosed with placenta previa accreta between July 2019 to December 2020 at Ain Shams University Maternity Hospital. All participants underwent conservative stepwise surgical approach through pfannenstiel skin incision with fetal delivery through uterine incision just above the upper border of the placenta, followed by bilateral uterine artery ligation with myometrial excision of the remaining adherent placenta and cervico-isthmic sutures. Among 62 women, the surgical approach was successful in controlling postpartum hemorrhage and preserving the women’s uterus in 50 [80.64%] participants. Three women [4.83%] had urinary bladder injuries, all were managed intraoperative during cesarean section. Five women [8%] had postpartum pyrexia and endometritis, all were managed conservatively with broad spectrum antibiotics. The stepwise surgical approach is safe and effective procedure that can be applied to the conservative management of placenta previa accreta.