Cesarean hysterectomy for placenta previa accreta, increta, and percreta: a strategic approach to minimize surgical hemorrhage.

Objective

A new approach to cesarean hysterectomy aimed at minimizing surgical hemorrhage in difficult cases of placenta previa accreta is introduced.

Methods

Diagnoses of placenta percreta with bladder invasion, and of placenta increta, respectively, were made by magnetic resonance imaging in two third-trimester patients with multiple previous cesarean deliveries and symptomatic placenta previa. Elective cesarean hysterectomy was planned in both cases. A novel approach to mobilization of the bladder and lower uterine segment at cesarean hysterectomy was applied in both cases.

Results

Cesarean hysterectomy by a modified approach was accomplished uneventfully in both cases. Blood loss was 900 mL and 1,100 mL respectively. Neither patient required blood component therapy.

Conclusions

A novel approach to cesarean hysterectomy result was associated with limited blood loss and without the need for blood component therapy in two patients at risk for surgical hemorrhage.