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Simple conservative surgery for placenta accreta spectrum without parametrial invasion: a novel uterus-sparing
Anh Duy Nguyen1,2,3, Ha Thi Thu Nguyen3,4, Thuy Bien Nguyen5
1Department of High-risk Pregnancy, National Hospital of Obstetrics and Gynecology (Nguyen), Hanoi, Vietnam.
Background:
Placenta accreta spectrum (PAS) is a life-threatening condition often managed by cesarean hysterectomy, resulting in numerous negative impacts on women's health. Most PAS cases do not involve parametrial invasion and may not require aggressive or complex surgical approaches. However, no simplified uterus-sparing technique exists for this subgroup. Therefore, we developed a novel surgical approach, "Simple Conservative surgical Approach for Placenta Accreta Spectrum - SCAPAS," tailored for PAS without parametrial invasion. SCAPAS included eight main steps.
Objectives:
To evaluate the efficacy and safety of SCAPAS in conservative surgical management of women with PAS without parametrial invasion.
Study Design:
This prospective study was conducted from January 2022 to June 2023 at Hanoi Obstetrics and Gynecology Hospital. Sixty-three women with PAS without suspected parametrial invasion, according to the prenatal ultrasound staging system for PAS disorder, underwent elective cesarean delivery using the SCAPAS technique at ≥35 weeks of gestation. Maternal and fetal outcomes were collected. Successful cases were defined as those achieved uterine conservation following SCAPAS without any life-threatening complications.
Results:
Of the 63 cases, 74.6% were patients under 35, and 66.7% had a history of two or more cesarean sections. The majority of women were diagnosed with PAS2 (69.8%). The success rate of SCAPAS was 85.7%. Success rates for placenta accreta, increta, and percreta were 100%, 82.4%, and 81.8%, respectively. The overall median intraoperative blood loss was 1200 mL (range 400-2500 mL), and the median duration of surgery was 80 minutes (range 35-124 minutes), with a mean interval from skin incision to fetal delivery was 30 minutes. Bladder injury and mild wound infections occurred in 6.3% (4/63) and 4.8% (3/63) cases, respectively. No patient required re-laparotomy. Total 20.6% of newborns had an Apgar score of less than 7 at 1 minute, but all recovered after 5 minutes.
Conclusions:
SCAPAS is a simple, safe, and effective surgical approach for conservative management of PAS without suspected parametrial invasion. Further studies are needed to develop a preoperative classification based on location, area, and degree of invasion to improve outcomes in PAS patients.
