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How to perform one-step conservative surgery for placenta accreta spectrum move by move

Published:November 10, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100802

      Abstract

      Background

      There are three treatment options for placenta accreta spectrum (PAS): cesarean section with hysterectomy, expectant management, and uterine sparing surgical techniques. One-step conservative surgery (OSCS) is the most extensively described conservative surgical technique and it has extensive evidence supporting its usefulness; however, few groups apply it, most likely due to the misconception that it is a complex procedure that requires extensive training and is applicable to only a few patients.

      Objective

      We evaluated the clinical outcomes of patients undergoing OSCS in 4 PAS reference hospitals and provided detailed steps for successfully applying this type of surgery.

      Study Design

      This is a multicenter, descriptive, prospective study that describes the outcomes of patients with PAS treated in 4 reference hospitals for this condition. The patients divided into those managed with OSCS and those managed with cesarean section and hysterectomy.

      Results

      Seventy-five patients were included. OSCS was possible in 85.3% of PAS cases (64 patients). Intraoperative staging and PAS topographic classification allowed for the selection of OSCS candidates. The clinical outcomes of the two groups were similar, except for the frequency of transfusions (81.8% vs. 67.2% in the OSCS group) and vascular interventions (27.3% vs. 4.7% in the OSCS group), which were both higher in patients who underwent hysterectomy. Additionally, the operation time was shorter in the OSCS group (164.4 minutes vs. 216.5 minutes).

      Conclusion

      OSCS is a valid procedure in most patients with PAS. It is an applicable technique even in scenarios with limited resources. However, its safe application requires knowledge of the topographic classification and the application of intraoperative staging.

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