Invasion anomaly or neovascularization? A new surgical approach for cesarean delivery in pregnant women with invasive placenta accreta spectrum disorder accompanied by placenta previa

OBJECTIVES: The objective of study is to describe a new surgical approach to cesarean delivery in women with invasive placenta accreta spectrum (PAS) accompanied by placenta previa. MATERIAL AND METHODS: Cesarean delivery was initiated with a transverse abdominal (Pfannenstiel) incision. A transverse incision was made above the vascular area in the lower uterine segment, and the fetus was delivered. The uterine fundus was removed from the abdomen and wrapped. Placental removal was started at posteriorly, continuing toward the anterior region. If dense adhesions were encountered, dissection was performed by inserting a finger between the adhesions to carefully separate them. It was recognized that two types of vessels develop to supply blood to the placenta. First, a perforating vessel emerges from adjacent tissues, entering the placental bed by perforating the uterine wall. Second, a superficial vessel runs along the uterine wall to enter the placental bed. The new emerging vessels were identified and ligated. Uterine sparing surgery was performed if the hemorrhage ceased. A cesarean hysterectomy was performed if hemorrhage did not cease. RESULTS: Eight cesarean deliveries were performed using this new surgical approach. Cesarean hysterectomy was performed in three patients in who want to sterilization diser and don't mind fertility preservation. Severe maternal morbidity, invasive procedures, intensive care unit admission, and relaparotomy were not required. CONCLUSIONS: The described new surgical approach provide surgeon to perform cesarean delivery without causing increase maternal morbidity and mortality. Although the approach is new and the study population is small, the results have acceptable rationality and applicability.