Multistep approach for control of postpartum hemorrhage in placenta accreta: a novel scheme in a tertiary referral center

Ahmed Samy El-Agwany, Tamer Mamdouh Abdeldayem


Background: Placenta accreta is a major cause for massive postpartum hemorrhage and consequent obstetric hysterectomy. Incidence is rising secondary to increased rates of caesarian delivery worldwide.

Methods: From January 2014 to January 2016, 25 women with anterior low-lying placenta and previous caesarian section(s) were recruited at El-Shatby Maternity university hospital in Alexandria, Egypt.  Cases had previous 1-4 lower segment caesarian deliveries. Cases were diagnosed as placenta accreta by ultrasonographic examination on admission to hospital. Elective surgery was done at 36-37 weeks. Mid line abdominal incision with upper segment uterine incision with plication of lowers uterine segment with transverse compression sutures.

Results: We present a clinical trial for conservative management of placenta accreta in 25 cases with 19 cases [76%] successfully managed without hysterectomy.

Conclusions: Conservative management of placenta accreta can be successfully performed in young age females desiring fertility.


Placenta, Accreta, Hysterectomy, Ultrasound, Hemorrhage

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