Pregnancy outcome in women with prior placenta accreta spectrum disorders treated with conservative-reconstructive surgery: analysis of 202 cases

Abstract

First viewing, hysterotomy aspect in a patient with a subsequent cesarean after conservative-resective surgery. Due to the entire invaded myometrial tissue is resected during the procedure, a new suture (hysterotomy) is performed in the upper segment. For this reason, the aspect is thicker than a primary cesarean.

Telemedicine facilitates surgical training in placenta accreta spectrum

“…OSCS has been included in management guidelines as an option for selected cases managed by trained teams 20 . Thus, few centers perform the procedure, although high success rates, 9 good neonatal outcomes, 10 and the possibility of uncomplicated pregnancies in the future have been reported 12 . The main reason for its infrequent use is the premise that extensive training is required, 20 and obstetricians are more familiar with the idea of performing an obstetric hysterectomy for all patients.…”

“…The selection of a controversial surgical procedure such as OSCS to assess the feasibility of virtual training in the management of PAS may divert attention from the primary objective, which is to explore new and easy options for surgical training in PAS, different than the traditional ones. Multiple concerns may appear about aspects such as future fertility in patients undergoing OSCS, risk of recurrence of PAS, advantages over hysterectomy, however, these considerations are beyond the scope of this work and should be addressed in other types of studies 9,10,12 …”

“…20 Thus, few centers perform the procedure, although high success rates, 9 good neonatal outcomes, 10 and the possibility of uncomplicated pregnancies in the future have been reported. 12 The main reason for its infrequent use is the premise that extensive training is required, 20 and obstetricians are more familiar with the idea of performing an obstetric hysterectomy for all patients. However, there are few references about the training required to perform a PAS hysterectomy.…”

“…Although the most used management for PAS is cesarean‐section hysterectomy, growing evidence exists to support the usefulness, 9 safety, 10 reproducibility, 11 and advantages of conservative‐resective surgical management 12 …”

“…Although the most used management for PAS is cesarean-section hysterectomy, growing evidence exists to support the usefulness, 9 safety, 10 reproducibility, 11 and advantages of conservative-resective surgical management. 12 We report the results of the execution of a virtual training program (VTP) and its successful implementation of PAS one-step conservative surgery (OSCS) in low-and middle-income countries (LMICs).…”