Conservative management of placenta previa-accreta by prophylactic uterine arteries ligation and uterine tamponade.
BACKGROUND
Placenta previa-accreta is associated with severe hemorrhage occurring while separating the placenta during cesarean delivery and hysterectomy is considered the treatment of choice. Conservative management has recently been proposed.


METHODS
A 26-year-old woman had pregnancy complicated by placenta previa with suspected accreta. During elective cesarean section a prophylactic double bilateral ligation of uterine arteries was performed before removal of the placenta; subsequently, the continuous small bleeding from the placental bed was stopped by tamponade with a balloon catheter filled with saline solution. The patient was discharged 5 days later. An ultrasonographic color Doppler follow-up demonstrated a renewed uterine vascularization.


CONCLUSIONS
Double bilateral ligation of uterine arteries can be used as a prophylactic surgical treatment when a severe bleeding because of placenta previa-accreta is expected, in order to avoid hysterectomy.
Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy. ferrazzani@tin.it
Sergio
S
Ferrazzani
Lorenzo
L
Guariglia
Stefania
S
Triunfo
Leonardo
L
Caforio
Alessandro
A
Caruso
D000328:Adult; D021721:Balloon Occlusion; D002404:Catheterization; D017604:Cesarean Section, Repeat; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008026:Ligation; D010921:Placenta Accreta / Q000000981:diagnostic imaging / Q000628:therapy*; D010923:Placenta Previa / Q000000981:diagnostic imaging / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D013536:Suture Techniques; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging / Q000601:surgery*