Article
Authors: Kamal M Zahran (Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt.) , Mostafa M Elsonbaty (Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt.) , Ahmed M Abbas (Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt.) , Abdel Ghaffar M Ahmed (Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt.) , Mohamed F Mostafa (Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Egypt) , Mansour A Khalifa (Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt.) , Ahmed Nasr (Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt.) , Ahmed F Abdel-Kawi (Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt.) , Alaa Eldin A Youssef (Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt.)
Background: Placenta accreta spectrum (PAS) has become a global problem secondary to the high rate of cesarean delivery (CD). The current study presents an effective surgical procedure (placental pouch closure) for uterine preservation in patients with PAS.
Methods: We applied this procedure in sixty cases at a tertiary university hospital between September 2017 and January 2019. We included women who were diagnosed as PAS based on preoperative ultrasound and Doppler evaluation, and who had the desire for uterine preservation.
Results: The procedure was successful in almost all cases; the uterus was conserved 98.33 % of participants, with no associated severe maternal morbidities or mortality. In all cases, no additional surgical procedures were needed. The mean blood loss was 1263 ml, and the mean number of units of blood required for transfusion was 2.31 units.
Conclusion: Identifying and meticulously closing the placental pouch is a novel surgical procedure for conservative management of PAS. In well-selected cases with the availability of facilities and expertise, the technique could have a place as a safe and effective surgical technique in women presenting with placenta accreta who desire uterine preservation.
Trial registration number: NCT03241849. Registered on August 8, 2017
Keywords: Placenta accreta spectrum, morbid adherent placenta, conservative management, placental pouch
How to Cite: Zahran, K. M. , Elsonbaty, M. M. , Abbas, A. M. , Ahmed, A. M. , Mostafa, M. F. , Khalifa, M. A. , Nasr, A. , Abdel-Kawi, A. F. & Youssef, A. A. (2020) “Placental pouch closure: a novel, safe and effective surgical procedure for conservative management of placenta accreta”, Proceedings in Obstetrics and Gynecology. 9(3). doi: https://doi.org/10.17077/2154-4751.1466