BACKGROUND Placenta accreta spectrum (PAS) disorders have become an emerging obstetric issue associated with risk of massive obstetric haemorrhage on placental separation following delivery. Antenatal diagnosis is of utmost importance but miserably limited due to lack of imaging expertise in this issue. We wanted to evaluate antenatal diagnosis of PAS disorders and analyse the outcome of definitive surgical approach. METHODS This is a prospective case series analysis done in the Department of Obstetrics and Gynaecology, RG Kar Medical College & Hospital, Kolkata. In a series, we have discussed 10 cases dealt well in our institution in the last one year (pre-Covid-era). Main outcome measures were operative blood loss, bladder injury, high dependency unit (HDU) admission, component transfusion, and neonatal morbidity. RESULTS Imaging expertise for prenatal diagnosis of PAS disorders was found miserably limited where 7 out of 10 cases were diagnosed intra-operatively. During Caesarean section (CS), longitudinal fundal incision was given to take out the baby with blood loss even less than usual CS. Bladder injury was diagnosed in one occasion intra-operatively. Peripartum total hysterectomy without touching placental bed was done in all cases, where uneventful bladder dissection and bilateral internal iliac artery ligation minimised component transfusion (8 out of 10) and HDU support (5 out of 10). Neonatal outcome was good in cases of planned CS at 36 weeks (6 out of 10). CONCLUSIONS Clinical suspicion plays an important role in our scenario due to lack of imaging experience & expertise to diagnose PAS disorders. Planned Caesarean delivery at late preterm period in equipped centre in expert hands improves outcome of such cases. Peripartum total hysterectomy without touching placental bed is the most definitive (surgical) approach with sound post-operative recovery. KEYWORDS Massive Obstetric Haemorrhage, Prenatal Diagnosis, Clinical Suspicion, Peripartum Total Hysterectomy, Internal Iliac Artery Ligation
Anterograde Transvaginal Total Hysterectomy: A Novel Surgical Approach to Hysterectomy
