Conservative management of placenta previa-accreta by prophylactic uterine arteries ligation and uterine tamponade

• Published in: Fetal diagnosis and therapy Vol. 25; no. 4; p. 400
• Main Authors: Ferrazzani, Sergio, Guariglia, Lorenzo, Triunfo, Stefania, Caforio, Leonardo, Caruso, Alessandro
• Format: Journal Article
• Language: English
• Published: Switzerland 01-01-2009
• Subjects: Adult; Balloon Occlusion; Catheterization; Cesarean Section, Repeat; Elective Surgical Procedures; Female; Humans; Ligation; Placenta Accreta - diagnostic imaging; Placenta Accreta - therapy; Placenta Previa - diagnostic imaging; Placenta Previa - therapy; Postpartum Hemorrhage - etiology; Postpartum Hemorrhage - prevention & control; Pregnancy; Suture Techniques; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Uterine Artery - diagnostic imaging; Uterine Artery - surgery
• ISSN: 1421-9964
• DOI: 10.1159/000236154

Placenta previa-accreta is associated with severe hemorrhage occurring while separating the placenta during cesarean delivery and hysterectomy is considered the treatment of choice. Conservative management has recently been proposed.
A 26-year-old woman had pregnancy complicated by placenta previa with suspected accreta. During elective cesarean section a prophylactic double bilateral ligation of uterine arteries was performed before removal of the placenta; subsequently, the continuous small bleeding from the placental bed was stopped by tamponade with a balloon catheter filled with saline solution. The patient was discharged 5 days later. An ultrasonographic color Doppler follow-up demonstrated a renewed uterine vascularization.
Double bilateral ligation of uterine arteries can be used as a prophylactic surgical treatment when a severe bleeding because of placenta previa-accreta is expected, in order to avoid hysterectomy.