Experience in Removal of Placenta Accreta with Uterus Preservation as a New Surgical Technique in Women with Previous Cesarean Deliveries

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.