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An Operative Technique for Conservative Management of Placenta Accreta

Nishijima, Koji MD; Shukunami, Ken-ichi MD; Arikura, Sayaka MD; Kotsuji, Fumikazu MD, PhD

doi: 10.1097/01.AOG.0000154005.24631.ec
Case Reports
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BACKGROUND: Control of bleeding is the goal of management for placenta accreta, which usually necessitates hysterectomy. A Committee Opinion of The American College of Obstetricians and Gynecologists (ACOG) has addressed the difficulties of conservative treatments.

CASES: Placentas of 2 primiparous women with placenta accreta were removed operatively from their uteri. One woman underwent a low transverse cesarean delivery, and the other had delivered vaginally. In each case, the anterior uterine wall was incised vertically between the lower segment and fundus before manual removal. After eversion of the uterus, the placenta was successfully detached from the uterine wall after intramyometrial administration of oxytocin.

CONCLUSION: A vertical incision in the anterior uterine wall and subsequent eversion of the uterus may aid in avoiding hysterectomy with placenta accreta.

A vertical incision in the anterior uterine wall and subsequent complete eversion of the uterus aids in manually removing placenta accreta.

From the Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan

Received April 26, 2004. Received in revised form June 7, 2004. Accepted June 9, 2004.

Address reprint requests to: Koji Nishijima, MD, Department of Obstetrics and Gynecology, University of Fukui, Matsuoka-cho, Yoshida-gun, Fukui 910–1193, Japan; e-mail: kojigyne@fmsrsa.fukui-med.ac.jp.

© 2005 The American College of Obstetricians and Gynecologists