An operative technique for conservative management of placenta accreta.
BACKGROUND
Control of bleeding is the goal of management for placenta accreta, which usually necessitates hysterectomy. A Committee Opinion of The American College of Obstetricians and Gynecologists (ACOG) has addressed the difficulties of conservative treatments.


METHODS
Placentas of 2 primiparous women with placenta accreta were removed operatively from their uteri. One woman underwent a low transverse cesarean delivery, and the other had delivered vaginally. In each case, the anterior uterine wall was incised vertically between the lower segment and fundus before manual removal. After eversion of the uterus, the placenta was successfully detached from the uterine wall after intramyometrial administration of oxytocin.


CONCLUSIONS
A vertical incision in the anterior uterine wall and subsequent eversion of the uterus may aid in avoiding hysterectomy with placenta accreta.
Nishijima
Koji
K
Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan. kojigyne@fmsrsa.fukui-med.ac.jp
Shukunami
Ken-ichi
K
Arikura
Sayaka
S
Kotsuji
Fumikazu
F
D000328:Adult; D002585:Cesarean Section / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods; D013513:Obstetric Surgical Procedures / Q000379:methods*; D010298:Parity; D010921:Placenta Accreta / Q000175:diagnosis / Q000601:surgery*; D011247:Pregnancy; D018570:Risk Assessment; D014597:Uterine Rupture / Q000517:prevention & control; D014599:Uterus / Q000601:surgery*