Conservative Treatment of a Placenta Accreta Case: Partial Segmental Uterine Resection

Abnormal placentation is associated with increased maternal morbidity and mortality. Placenta accreta (PA) is one of the most feared complications in obstetrics; it occurs when the placenta is abnormally adherent to the uterus. PA is defined as the penetration of trophoblastic tissue into the myometrium. The incidence of PA has been reported to be as much as one in 533 pregnancies, based on Wu et al study (1) . PA can lead to serious preoperative, intraoperative, and/or postoperative bleeding. Treatment options for postpartum hemorrhage include conservative management with uterotonic drugs, selective devascularization by ligation or embolization of the uterine artery, external compression with uterine sutures (B-Lynch, Hayman, Cho), and intrauterine packing (2). The usual surgical approach would involve selective ligation of the ascending uterine arteries above the cervical isthmus. The technically more demanding hypogastric artery ligation may then be considered, if bleeding persists (3). Severe hemorrhage can be life threatening, and often a hysterectomy is required. Since this leads inevitably to loss of fertility, a fertility sparing approach is desirable. Accordingly, conservative management is sometimes considered as an option today, except in cases of heavy hemorrhage or disseminated intravascular coagulation.We aimed to report a case of PA which was successfully managed with partial segmental resection of uterus.