Objective: Cesarean section rates are increasing with associated increase in placenta previa
and accreta. Placenta accreta is a major cause of maternal morbidity and mortality. Our
objective was to evaluate of a new method of combined surgical steps in management of morbidly
adherent placenta (MAP) to face its burden, psychological and marital disintegration if managed
by hysterectomy in our low facilities.
Materials and Methods: In this case series, we evaluated the use of sequential surgical steps for
conservative management of 20 cases of MAP as regard the intra-operative and post-operative
outcomes in Assiut Women Health Hospital, Egypt from June to December 2014. The sequential
steps started by perfect dissection of urinary bladder, then delivery of the fetus followed by
exteriorization of the uterus and application of 4 ring forceps on both uterine and ovarian vessels.
Trial of placenta removal followed by application of two towels in the uterine cavity to achieve
hemostasis. Ligation of uterine artery bilaterally at double low level. Finally, plication of the
friable lower uterine segment from anterior wall after removal of towels.
Results: The mean age of the included women was 29.95±4.8 years. All cases had previous
uterine scar and placenta previa. Ten cases (50%) had placenta accreta, 8 cases (40%) had
placenta increta and 2 cases had placenta percreta. Our procedure was succesfulin all 18 cases
of placenta accreta and increta but 2 cases of placenta percreta required hysterectomy.
No postpartum hemorrhage in all cases. There were no maternal deaths.
Discussion: This new method was favorable in the management of MAP and decreased the
incidence of hysterectomy in cases of placenta accreta and increta.