ONE STEP TOWARDS SAVING MOTHERHOOD IN PLACENTA ACCRETA SPECTRUM: AN INNOVATIVE SURGICAL APPROACH

Dr. Shirish S. Dulewad, Dr. Prutha P. Kalyani* and Dr. Aishwarya J. Jivtode

ABSTRACT

Background: Placenta accreta spectrum (PAS), or morbidly adherent placenta, is a pathologic adherence and excessive penetration of placenta into myometrium, including accreta, increta, or percreta, which continues to be challenging for obstetricians worldwide. We present an innovative conservative surgical technique in patients with PAS disorders that can significantly reduce maternal morbidity and mortality. Methods: Study was conducted at a tertiary care centre in Maharashtra, India, and included 53 cases of PAS. The technique uses a transverse skin incision and uterine incisions, followed by uterus repositioned anteriorly with placenta in situ, stepwise devascularization with B/L internal iliac artery ligation and B/L uterine artery ligation, reducing blood supply to uterus up to 80%. Placenta is allowed to separate spontaneously, or manual removal done. If needed, hemostatic sutures on placental bed or cervicoisthmic sutures taken. Uterus and abdomen then closed as usual. Results: Among 29,778 deliveries, 53 cases of PAS seen with incidence of 0.17% i.e., 1.7:1000 births, including 31 cases of accreta, 19 of increta, and 03 of percreta cases. The gestational age of termination of pregnancy was at 37 to 38 weeks, there was less estimated blood loss, fewer ICU admissions, no incidences of secondary PPH, DIC, bladder injury, or need for re-exploration or delayed hysterectomy, and no maternal mortality.Conclusions: We recommend this procedure as a novel technique and safe alternative to peripartum hysterectomy and other conservative surgical management procedures for PAS. This technique preserves uterus as well as reduces blood loss, transfusion requirement, and maternal morbidity and mortality while preserving fertility

Keywords: Placenta accreta, conservative surgery, stepwise devascularization.