Simplified Conservative Measures in Managing Morbidly Adherent Placenta in Beni-Suef University

Beni-Suef University Hospital Simplified Conservative Approach for Managing Placenta Accreta Spectrum: RCT

To evaluate the efficacy of modified uterine artery ligation and myometrial compression as a conservative measure in improving the prognosis of the morbidly adherent placenta.

According to the International Federation of Gynecology and Obstetrics (FIGO) guidelines, the principal surgical strategy to prevent excessive bleeding related to placenta accreta syndrome is to leave the placenta in situ and perform a primary peripartum hysterectomy at delivery. A hysterectomy may not be preferred by patients wishing to preserve fertility and is detrimental to multiple aspects of the pelvic floor, bowel, and physical functions.

Surgical principles in placenta accreta syndrome include avoiding disruption of the hypervascular placenta, stepwise devascularization, early and comprehensive blood product transfusion, and judicious use of interventional radiologic techniques such as vascular embolization.

Conservative management describes any approach whereby hysterectomy is avoided

Inclusion Criteria:

• Gestational age more than 28 weeks as determined by LMP and ultrasound.
• Placenta previa as confirmed by ultrasound.
• Clinically stable with no or mild vaginal bleeding.
• No evidence of fetal compromise.
• Patient consent.

Exclusion Criteria:

• Vaginal bleeding
• Medical disorders