New Insights Into Pre And Intraoperative Interventional Startegies To Reduce Pph During Cesarian Hystrectomy In Placenta Accreta Spectrum

Abstract

Placenta accreta spectrum (PAS) represents a recently recognised continuum of abnormal placental invasion, including placenta accreta, increta and percreta, which is a rare, life-threatening complication of pregnancy affecting both mother and foetus, characterised by placental invasion beyond the serosa, often involving adjacent structures such as the urinary bladder. The increasing incidence is associated with rising caesarean section rates and other related factors such as advanced maternal age and infertility treatments. Surgical management remains challenging due to the risk of extensive bleeding, urological injuries and increased maternal morbidity. This study aimed to assess the efficacy of various pre and intra op interventional strategies to reduce PPH during cesarian hysterectomy in PAS disorders. This study presented data of 50 women (2022-2025) who underwent cesarean hysterectomy (CH) for PAS disorders, from tertiary care center at Hyderabad. Women with ongoing pregnancy >24weeks GA with previous one or more cesarean section & placenta previa with USG features of PAS were included. With all the above implemented strategies mean blood loss was 1.5- 2lts, bladder injury in 6 out of 50patients, ICU admission for >24 hrs in 15 patients and all 50 patients were discharged healthy with no mortality seen. Our data supported that these simple approaches and maintaining a checklist effectively helped in reducing PPH   without requiring any high-end Procedures like prophylactic uterine artery balloon Cather placement thus can be implemented in developing countries..