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1. Surgical Aproach to
Placenta Accreta
Dr. Muhammad Atif Khan
Assoc. Prof. Surgery
Holy Family Hospital, Rwp

2.  A severe complication of pregnancy
 Risk for massive and potentially lifethreatening
intrapartum and postpartum haemorrhage.
Placenta Accreta

3. Accreta 75%
Increta 18%
Percreta 7%
Incidence
A.C.O.G: American College of Obstetricians and Gynecologists
67% in patients with placenta praevia and multiple previous c/s.

4. Types

5. Pathogenesis

6. Management

7.  The definitive treatment of placenta accreta
is cesarean hysterectomy.
1. Conventional cesarean hysterectomy
2. Modified cesarean hysterectomy (MCH)
3. Posterior retrograde abdominal
hysterectomy
Cesarean hysterectomy

8.  Mid-longitudinal incision of the lower abdomen
 An oblique or “J” shaped incision in the lower uterine
segment is often applied.
 Delivery of the fetus.
 Application of elastic bandage tourniquet around the
level of the cervical internal os.
Modified cesarean hysterectomy
(MCH)

9. (A) Cord clamping. (B) Cervical ligation by Foley's catheter. (C) Cessation of bleeding after cervical
ligation.

10.  Lithotomy position
 Fundal hysterotomy away from the placenta.
 Hysterotomy closure with a continuous suture
(for aemostasis).
 Ligature of the anterior divisions of the internal
iliac arteries.
 Posterior vaginal fornix is exposed by placement
of a sponge stick into the vagina, which is
opened transversely, 1–2 cm below the
cervicovaginal junction.
 Caesarean hysterectomy via posterior
retrograde approach.
Posterior retrograde abdominal
Hysterectomy

12.  Easy identification of the vagina and early uterine
devascularisation.
 Safe resection of the involved urinary bladder.
Advantages

13.  Publications Committee, Society for Maternal-Fetal
Medicine, Belfort MA. Placenta accreta. Am J Obstet
Gynecol 2010;203:430–9.
 Faranesh R, Romanov S, Shalev E, Salim R. Suggested
approach for management of placenta percreta invading
the urinary bladder. Obstet Gynecol 2007;110:512–15.
 Committee on Obstetric Practice. Committee opinion no.
529:placenta accreta. Obstet Gynecol 2012;120:207–11.
Refrences