title: Transverse uterine fundal incision for placenta praevia with accreta, involving the entire anterior uterine wall: a case series.
abstract: OBJECTIVE
  To determine the feasibility and safety of transverse fundal incision with manual placental removal in women with placenta praevia and possible placenta accreta.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Four level-three Japanese obstetric centres.
  
  
  METHODS
  Thirty-four women with prior caesarean section and placenta praevia that widely covers the anterior uterine wall, in whom placenta accreta cannot be ruled out.
  
  
  METHODS
  A transverse fundal incision was performed at the time of caesarean section and manual placental removal was attempted under direct observation.
  
  
  METHODS
  Operative fluid loss.
  
  
  RESULTS
  The total volume of fluid lost during our operative procedure compares favourably with the volume lost during our routine transverse lower-segment caesarean sections performed in patients without placenta praevia or accreta. The average fluid loss was 1370 g. No patients required transfer to intensive care, and there were no cases of fetal anaemia.
  
  
  CONCLUSIONS
  This procedure has the potential to reduce the heavy bleeding that arises from caesarean deliveries in women with placenta praevia and placenta accreta.
authors: Department of Obstetrics and Gynaecology, University of Fukui, Fukui, Japan.
authors: F
authors: F
authors: Kotsuji
authors: K
authors: K
authors: Nishijima
authors: T
authors: T
authors: Kurokawa
authors: Y
authors: Y
authors: Yoshida
authors: T
authors: T
authors: Sekiya
authors: M
authors: M
authors: Banzai
authors: H
authors: H
authors: Minakami
authors: Y
authors: Y
authors: Udagawa
mesh_terms: D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007564:Japan / Q000453:epidemiology; D010921:Placenta Accreta / Q000175:diagnosis / Q000601:surgery*; D010923:Placenta Previa / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D011247:Pregnancy; D014592:Uterine Hemorrhage / Q000517:prevention & control*; D014599:Uterus / Q000473:pathology / Q000601:surgery*
keywords: Caesarean section; placenta praevia accreta; transverse uterine fundal incision