Summary Traditionally the treatment for invasive cervical carcinoma which has progressed beyond micro invasion has been radical hysterectomy, unfortunately directly affecting fertility. Long term experience of radical surgery for Stage IB carcinoma has shown that it produces excellent results in terms of survival; however there is always a loss of potential for future fertility. Increasingly large numbers of young women (24-35 years) are being diagnosed with cervical cancer (7). Saving uterus where is safely possible is the main challenge to a surgeon as the loss of fertility for women can be devastating. Approximately one-third of infertility is attributed to the female partner, one-third attributed to the male partner and one-third is caused by a combination of problems in both partners. The incidence of a cervical cancer diagnosis in reproductive age women has increased in parallel to the quality in diagnostic in Latvia. However along with a scientifically evident knowledge, new surgical techniques and modern technologies we have recently started implementation of a fertility saving surgeries.

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Background. Abnormally invasive placentation (AIP) is a clinical term that describes situation when placenta does not separate spontaneously after delivery and its manual removal causes excessive bleeding (1). Historically, the treatment of choice for this condition is hysterectomy. Lately, the new treatment option, conservative management of the AIP, has proven itself an effective alternative to hysterectomy in carefully selected patients (2). However, the use of conservative AIP management is limited in many countries, the reasoning being the lack of doctors’ experience in this procedure and concerns regarding a high postpartum infection rate. Case reports. We present the first two cases of conservative management of AIP in Latvia. Most of prenatally diagnosed AIP cases country-wide are referred to the Paul Stradinš University Hospital, which is a tertiary referral hospital. The annual rate of AIP in the hospital varies from five to ten cases. Two pregnant women were diagnosed with AIP prenatally, both of them refused hysterectomy and therefore went for the conservative management of AIP. During Caesarean section operation, placentas were left in situ after delivery of the baby. During the follow-up period of 12 and 14 weeks, both women developed infection complications, but complete placental tissue resolution was diagnosed in the end. Conclusion. These two cases demonstrate that conservative management of AIP can be safely applied in small countries/areas with small AIP rate and management experience.