Conservative Management of Placenta Accreta Using Helium Plasma Focused Radio Frequency Energy [11N]

Abstract

INTRODUCTION: Abnormal placentation, including placenta accreta, have been occurring at a higher incidence than before due to the increase in cesarean sections. The gold-standard treatment if uncontrolled bleeding occurs is peripartum hysterectomy, depriving woman of future fertility. The purpose of this case was to apply a conservative management by using a helium plasma device to fulgurate the placenta accreta at the uterine site. METHODS: Patient informed consent was obtained for submission of a case report. Cesarean delivery with low-vertical incision and manual extraction of the placenta was performed. The uterus was exteriorized and the helium plasma radio frequency (RF) device (J-Plasma system) was used to fulgurate the retained placental tissue, confirming hemostasis with a radius of 3 cm from the site. Hemabate was given to the site to maintain uterine contraction. RESULTS: The helium plasma device provided adequate hemostasis to the 12.76 cc of retained placenta accreta at 40% power 4 L/min gas flow, reducing lateral and depth damage of normal endometrial tissue. Quantitative blood loss was 560 cc. Obstetric hemorrhage and peripartum hysterectomy were avoided, allowing for future fertility. CONCLUSION: The helium plasma RF device provided a high-precision and efficient operative time in conservatively managing placenta accreta. This adds a safer alternative form of managing abnormal placentation and avoiding radical treatment. More research and trials should be done on larger placenta accreta and on other morbidly adherent placentas. It will be able to allow woman of high-risk to maintain their ability of reproducing in the future since a peripartum hysterectomy could be avoided.