Abstract
Background: Owing to high risks of maternal morbidity, surgical complications, and loss of fertility, including psychological trauma caused by cesarean hysterectomy, innovative approaches for uterine preservation have been investigated. This study aimed to determine the efficacy of a novel eight-step surgical protocol for uterine preservation in placenta accreta spectrum (PAS) overlying the previous cesarean scar.Methods: We retrospectively studied consecutive patients with PAS overlying the cesarean scar, who were treated between December 2015 and October 2019 using the protocol. The depth and extension of placental invasion and severity of pelvic adhesion were assessed intraoperatively. Information regarding the gestational week at surgery, surgery duration, estimated blood loss (EBL), bladder injury, and post-procedural recovery was retrieved from the hospital database. Multiple linear regression was used to analyze factors influencing surgical blood loss. EBL was compared between the perioperative aortic balloon and non-balloon groups in severe cases using t-tests.Results: Overall, 115 patients with PAS were included. The mean EBL and surgery duration were 1666.1±1379.0 mL and 2.2±0.8 h, respectively. The uterus was successfully preserved in all patients with one surgery. Incidences of placenta accreta, increta, and percreta were 40 (35.8%), 46 (40.0%), and 29 (25.2%) cases, respectively. Extensive placental invasion and cervical involvement were observed in 41.7% and 28.7% of patients, respectively. EBL was significantly correlated with the extent of placental invasion, cervical involvement, and pelvic adhesion. No difference was seen in EBL between the balloon and non-balloon groups among the 44 patients with severe PAS.Conclusion: The eight-step protocol is effective for uterine preservation in PAS overlying the cesarean scar. EBL is affected by the extent of placental invasion, cervical involvement, and severity of pelvic adhesion. Perioperative aortic balloon should be used conservatively.
Placenta Accreta Spectrum Disorders and Cesarean Scar Pregnancy Screening: Are we Asking the Right Questions?
