Introduction:
Placenta accreta spectrum (PAS) covers a spectrum of abnormally invasive
placentation including placenta accreta, increta and percreta. The
incidence of PAS with placenta previa has been increasing as the
consequence of the world-wide rising cesarean section (CS) rate, from 1
in 4000 deliveries in the 1970s to 1 in 500 recently.1The major problem of PAS is severe and sometimes life-threatening
hemorrhage, which results in massive blood transfusion, coagulopathy,
hysterectomy, need for re-operation, even maternal death. The optimal
surgical management for PAS remains uncertain. Elective cesarean
hysterectomy without disrupting the placenta, was the most generally
accepted approach.2-4 Delayed hysterectomy after
cesarean delivery with the placenta left in situ, was also reported to
decrease blood loss.5-6 However, this approach need
two major surgeries, and the delay poses a risk of bleeding or infection
that may require emergency surgery.
Due to the high maternal morbidity and surgical complications, in
addition to loss of fertility and its accompanying psychological trauma
caused by cesarean-hysterectomy, innovative approaches are being
investigated for uterine preservation. These methods include
preoperative arterial balloon ,7,8 pelvic arterial
ligation,3 compression sutures,8-10local resection and uterine reconstruction.11,12However, the successful rate of
uterine preservation in literatures varied greatly, and the sample size
of studies with total uterine preservation are not large enough for an
reassuring consensus.
Under this circumstances, a step-by step protocol was developed in our
group and has been used for uterine preservation in PAS patients. The
procedure details and the surgical outcomes are provided.