One step conservative surgery: an approach to manage placenta accreta spectrum


  • Soniya Dahiya Department of Obstetrics and Gynaecology, PT. BD Sharma, PGIMS, Rothak, New Delhi, India
  • Pushpa Dahiya Department of Obstetrics and Gynaecology, PT. BD Sharma, PGIMS, Rothak, New Delhi, India
  • Shweta Jain Department of Obstetrics and Gynaecology, PT. BD Sharma, PGIMS, Rothak, New Delhi, India
  • Sunita . Department of Pathology, PT. BD Sharma, PGIMS, Rothak, New Delhi, India



One step conservative surgery, Placenta accreta spectrum, Postpartum hemorrhage, Segmental resection


The incidence of placenta accreta spectrum (PAS) has been arisen over past few decade, attributed to increasing caesarean section rate from 1:2500 to 1:500. Caesarean hysterectomy cases are increasing to prevent morbidity and mortality in PAS. The conservative approach for PAS is to prevent postpartum hemorrhage and to preserve the uterus. We present a case of placenta accreta spectrum where we had done one step conservative surgery. A 35year old woman G3P2A0 with 32 weeks of twin pregnancy with previous caesarean section with complaints of premature rupture of membrane was admitted in emergency labour room. Patient went into preterm labour on third day of admission and delivered two live preterm babies. Placenta could not be removed after delivery. Manual removal of placenta was tried but placenta could not be removed completely and bleeding was excessive after the procedure. Medical management of postpartum hemorrhage was done. On local examination there was no cervico-vaginal tear and laceration, upper segment of uterus appeared to be well contracted, lower segment ballooned up and bleeding was still excessive. Decision of emergency laparotomy was taken. Patient underwent emergency laparotomy for postpartum hemorrhage followed by segmental resection of invaded area, bleeding stop. Post operative period is uneventful.In young and low parity patient, one step conservative surgery can be considered a uterine preserving approach in the absence of placenta praevia.


Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One. 2012;7(12):e52893.

Sentilhes L, Kayem G, Chandraharan E, Palacios‐Jaraquemada J, Jauniaux E. FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management. Int J Gynecol Obstet. 2018;140:291-8.

Malhotra V, Bhuria V, Nanda S, Chauhan M, Rani A. Placenta Accreta: Five year experience at a tertiary care centre. J Gynecol Surg. 2014;30(2):91-5.

Rani V, Jain S, Nanda S, Malhotra V, Chauhan M, Sangwan N. Placenta accrete spectrum-management and fetomaternal outcome at a tertiary care centre. Inte J Clinical Obstetrics and Gynaecology. 2019;3:10.

Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107:1226-32.

Zosmer N, Fuller J, Shaikh H, Johns J, Ross JA. Natural history of early first-trimester pregnancies implanted in Cesarean scars. Ultrasound Obstet Gynecol. 2015;46:367-75.

Belfort MA. Publications Committee, Society for Maternal-Fetal Medicine. Am J Obstet Gynecol. 2010;203(5):430-9.

Comstock CH, Bronsteen RA. The antenatal diagnosis of placenta accreta. BJOG. 2014;121:2

Jauniaux ERM, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL, et al. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG. 2018

Palacios-Jaraquemada JM. Diagnosis and management of placenta accreta. Best Pract Res Clin Obstet Gynecol. 2008;22:1133-48.

Palacios-Jaraquemada JM. Placental Adhesive Disorders. Berlin/ Boston. Walter de Gruyter. 2012.

Palacios-Jaraquemada JM. One-Ste Conservative Surgery for Abnormal Invasive Placenta (Placenta Accreta–Increta–Percreta). In: A Comprehensive Textbook of Postpartum Hemorrhage. An essential clinical reference for Effective Management. Arulkumaran S, Karoshi M, Keith LG, Lalonde AB, B-Lynch C, eds. 2nd Edition. London: Sapiens Publishing GLOWM. 2012;263-71.

Palacios-Jaraquemada JM, Pesaresi M, Nassif JC, Hermosid S. Anterior placenta percreta: Surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand. 2004;83:738-44.

Shabana A, Fawzy M, Refaie W. Conservative management of placenta percreta: A stepwise approach. Arch Gynecol Obstet. 2015;291(5):993-8.

Palacios-Jaraquemada JM, Fiorillo A, Hamer J, Martínez M, Bruno C. Placenta accreta spectrum: a hysterectomy can be prevented in almost 80% of cases using a resective-reconstructive technique. J Matern Fetal Neonatal Med. 2020;1-8.






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