A Novel Uterus-Sparing Technique for Placenta Accreta Spectrum (PAS), at a Tertiary Center.

OBJECTIVE

To present and evaluate the outcomes of a novel targeted devascularization technique for managing a placenta accreta spectrum (PAS).

DESIGN

Prospective observational study.

SETTING

The main tertiary care center in Saudi Arabia.

POPULATION: Sixty-seven referred pregnant women with a previous cesarean section scar, placenta previa, and sonographic diagnosis of PAS.

METHODS

Patients with PAS underwent targeted devascularization of the lateral sides of the uterus between cervix, and round ligament insertion at the time of caesarean delivery. Primary outcomes included uterine preservation rate and maternal morbidity. Secondary outcomes were transfusion requirements, surgical time, maternal and neonatal outcomes, estimated blood loss, transfusion rate, and bladder injury.

RESULTS

Among 67 patients, conservative surgery was successful in 95.5%, with a mean blood loss of 1.57 ± 0.81 L and 82.1% requiring blood transfusion. Bladder injury occurred in 22.4% and was managed intraoperatively. Surgical performance improved over time with reduced transfusion requirements (p = 0.004) and shorter operative times (p = 0.002). No long-term complications or a maternal death were recorded.

CONCLUSIONS

Targeted devascularization of the lateral side of the uterus is a safe and effective uterus-sparing approach for PAS, associated with low morbidity and improved operative efficiency over time.