Background: The placenta accreta spectrum (PAS) is
a worldwide health problem due to increasing cesarean
section rates. A severe maternal complication can occur
due to bleeding and invasion of nearby organs. Although
many techniques were described to help in intraoperative
management, no standard agreement on the best one, and
unfortunately, in many conditions, cesarean hysterectomy
can only save the mother's life. There's a must to find out
new techniques that could help in preserving the uterus.
Objective: This prospective study was taken on 26 patients at Mansoura University Hospital diagnosed with
PAS. There were 13 cases PAS grade 1, 7 cases grade 2,
6 cases grade 3A. All the cases were electively delivered
at 37 w. Purse string suturing was done to plicate the lower uterine segment and provide natural tamponade to decrease blood loss from the placental bed and preserve the
uterus.
Results: the success rate of the procedure in preserving
the uterus was 96%. The average blood loss was 1557.69
± 318.96. Massive blood loss (2500 ml) occurred in 1
case, intraoperative after the procedure. The procedure is
simple, not time-consuming, and no special skills are required. A large number of patients and long term follow
up are needed to ensure the efficacy of the procedure and
the state of future fertility.
Conclusion: management of patients with PAS should be
individualized according to PAS grade and patient wishes. The purse-string suure technique can help in reducing
blood loss and decrease the cesarean hysterectomy rate