Conservative Surgical Approach for Placenta Accreta Spectrum

Abstract

Placenta accreta spectrum disorder (PAS), which is defined as the situation in which the placenta would not detach after delivery spontaneously, is closely associated with high maternal and neonatal morbidity and mortality resulting from massive bleeding. The prevalence of PAS is increasing globally. When hysterectomy is proposed as the main intervention by international societies, uterine preservation surgery is widely performed in China. Techniques have been developed accordingly, in order to control intraoperative bleeding. In this chapter, we summarize the up-to-date techniques applied in cesarean section for PAS, including precise antenatal diagnosis and assessment (Ultrasound and MRI), preoperative preparation (PAS prenatal grading system and multidisciplinary team), intraoperative hemostasis (applying the Foley catheter on the lower uterine segment, arterial balloon blockade, vascular embolization, artery ligation), modified and/or innovative suture techniques and intraoperative cell salvage.