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

Abstract

Objectives: To evaluate and describe a surgical approach for uterine preservation and management ofpostpartum hemorrhage in placenta accreta spectrum (PAS).Methods: We analyzed the data of patients who were diagnosed with placenta previa companied with PASprenatally and subsequently performed cesarean section with local resection technique to manage postpartumhemorrhage and uterine preservation at our tertiary care center between January 2016 and August 2017. Thetechnique includes the local resection of placental invasion site and suturing the new uterine edges withoutinternal 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 meanoperative time was 99 ± 30 minutes. The mean received packed red blood cells was 2.3 ± 1.0 units. The meanlength of postoperative hospital stay was 4.5 ± 1.4 days. There was no late complications regardingcoagulopathy and infection. No maternal mortality was observed.Conclusion: Local resection is an effective, safe and fertility preserving approach in selected patients withPAS.