The Effect of Routine Combined utero-ovarian and Uterine vs. Uterine Artery Ligation in Patients with Partially Separated placenta as part of Placenta Accreta Spectrum Undergoing Elective Cesarean Section

Abstract

bstetric hemorrhage is one of the most prevalent causes of maternal morbidity and mortality worldwide, leading to about 25 % of all direct perinatal maternal deaths (Goodburn and Campbell, 2001). One of the major causes is of obstetric hemorrhage is the catastrophic obstetric emergency: placenta accreta spectrum, responsible for 1 % of maternal mortality in the United States (Clark et al., 2008). Placenta accreta spectrum, formerly known as morbidly adherent placenta refers to the range of pathologic adherence of the placenta, including placenta accrete, placenta increta and placenta percreta (Shellhaas et al., 2009). When the extent of the placenta accreta is limited in depth and surface area, and the entire placental implantation area is accessible and visualised (i.e. completely anterior, fundal or posterior without deep pelvic invasion), uterus preserving surgery may be appropriate, including partial myometrial resection (RCOG, 2018). The main advantage of conservative surgical management of placenta accreta spectrum is that it appears to have