Important surgical measures and techniques at cesarean hysterectomy for placenta previa accreta

Abstract

For cesarean hysterectomy with placenta previa accreta, "universally achievable" measures are required. We propose eight measures: (i) placement of intra-iliac arterial occlusion balloon catheters; (ii) placement of ureter stents; (iii) "holding the cervix" to identify the site to be transected; (iv) uterine fundal incision; (v) avoidance of uterotonics; (vi) "M cross double ligation" for ligating the ovarian ligament; (vii) "filling the bladder" to identify the bladder separation site and "opening the bladder" for placenta previa accreta with bladder invasion; and (viii) to continue to clamp the medial side of the parametrium or the cervix or employment of the "double edge pick-up" to ligate it. These eight measures are simple, easy, effective, and thus "universally achievable".

Which type of placenta previa requires blood transfusion more frequently? A new concept of indiscernible edge total previa

“…However, autologous blood was not prepared in 63 patients for the following reasons: Hb < 10.0 mg/dL (n = 28); no time to prepare (n = 21); impending preterm delivery (n = 8); or refusal (n = 6). In 15 patients with suspected AIP based on both ultrasound and MRI, then confirmed by histological examination, we performed elective cesarean hysterectomy, as previously described 13 Of the 307 patients, 17 had AIP: 15 (88%) received elective cesarean hysterectomy as described, while the remaining two underwent emergency cesarean hysterectomy. We also retrieved data on maternal characteristics and perinatal outcomes, including body mass index, conception after artificial reproductive technology, intensive care unit (ICU) admission, gestational age at delivery, birthweight, Apgar score and umbilical artery pH.…”

Abnormally invasive placenta: an overview of diagnosis and management options

“…To some extent our surgical strategy was similar to Matsubara S like ligation of IIA and UA, holding of cervix, filling the bladder for identification of the bladder top and to check the integrity of bladder. 17 We placed uretral stunts in two cases like Tam which really helped to reduce ureteric injury. 18 The decision to perform a caesarean hysterectomy or conservative management is based on the extent of infiltration, patients hemodynamic condition, her desire to remain fertile.…”

Uterine Compression Suture for Cesarean Hysterectomy: Possible Applications to Conditions other than Atonic Bleeding

“…This does not mean that hysterectomy per se caused this high maternal mortality but situations requiring this surgery may eventually cause it. Indeed, cesarean hysterectomy is one of the most difficult obstetric surgeries and is always challenging [8]. Every effort should be made to make this surgery easier and safer.…”