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.