Conclusions

The efficiency of this protocol lead to our becoming a reference center for the management of placenta accreta beyond the borders of our region. Logistically, the process is made easier because all the operative units involved are located in the same building.
In these high-risk patients, some elements were very important:
Using the protocol described, we treated more than 20 patients, some of them with the most severe forms of PAS disorders (placenta increta and percreta). We obtained positive results in terms of bleeding, packed red blood cells used, postoperative sequelae, and UTI admissions. No patients died. Most patients had a previous cesarean section.
Few procedures were carried out in an emergency regimen, where general anesthesia was used. Consistent with literature8, they required the greatest amount of blood products. However, based on our experience for both elective and emergency surgeries, fibrinogen administration considerably reduced the need for PRBC. Among those treated with an elective regimen, blood loss never exceeded 1800 mL.