Conservative Rx in placenta accreta and percreta: a case stu
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This series describes an innovative approach for anterior placenta percreta surgery.

After placenta percreta was diagnosed, if no contraindications were found, surgery during the 35th week was planned. The surgical team decided the appropriate strategy.

An median infra-umbilical incision with a small supra-umbilical extension, allowed to bring forward the uterus and perform a fundic hysterectomy. After the baby was delivered, the infrarenal abdominal aorta was isolated and a loop was placed (proximal vascular control).

Subsequently, all newly formed vessels between the uterus and placenta were isolated and ligated to completely release both vesicouterine and vesicocervical spaces. The aortic loop was secured and the placenta removed. Uterine arteries were selectively ligated.

After the uterine cavity was cleared, the anterior wall was repaired using a reabsorbable mesh, collagen, and fibrin glue. Finally, the uterus and bladder were set apart by an anti-adhesive layer. The aortic loop was removed, the pelvis was drained, and the abdominal wall was closed.

Long-term postoperative results were excellent, with optimal tissue repair. Patients have been able to bear other children uneventfully. Protracted ileum (3-4 days) was the most frequent postoperative complication.

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