Aortic clamping for limiting blood loss at cesarean hysterectomy for placenta percreta: A case series

Abstract

Placenta accreta spectrum (PAS), particularly placenta percreta, is a dreaded complication of pregnancy in which there is abnormal invasion of placental trophoblast into the muscular wall of usually the lower segment of the uterus and the adjacent urinary bladder with abundant neo-vascularization in the utero-vesical space. Rising cesarean section rates 1 and in vitro fertilization conceptions 2 ensure increasing incidence of PAS disorders.One definitive method of care is classical cesarean section followed by total hysterectomy without disturbing the placenta.Another approach is to resect the part of the myometrium invaded by the placenta and repair the defect to conserve the uterus. 3,4 The major challenge is to control blood loss during separation of the bladder from the invaded lower segment so that remaining steps of hysterectomy can be completed. The numerous newly

Managing Placenta Accreta Spectrum in Low Resource Setting Using a Novel Dissection-Free Aorta Clamp: Operative Technique

“…al 2021 and Sucu et.al 2020 (Common iliac artery), reveals promising results with radically reduced average estimated blood loss (595ml -2296ml) with only 6.5 to 25% of urological injuries reported and an average 2 to 6 units of pRBC transfusion requirement. Reassuringly, none reported any distal thromboembolic phenomena (9)(10)(11). Thus, aortic cross-clamping reveals similar effectiveness, feasibility and safety profile at least on par with or even superior to aortic balloon occlusion, pending comparative trials (12).…”

Managing placenta accreta spectrum in low‐resource settings using a novel dissection‐free aorta clamp: Operative technique

“…This technique, when adopted into PAS management and reported as small, single‐center trials by Chou et al 2021, Joshi et al 2021, and Sucu et al 2020 (common iliac artery), reveals promising results with a radically reduced average estimated blood loss (595–2296 ml) with only 6.5 to 25% of urological injuries reported and an average 2 to 6 units of pRBC transfusion requirement. Reassuringly, none reported any distal thromboembolic phenomena 12–14 . Thus, aortic cross‐clamping reveals similar effectiveness, feasibility, and safety profile at least on a par with or even superior to aortic balloon occlusion, pending comparative trials 15 …”