August 2016 · Volume 5 · Issue 8 Page 2799 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Elagwany A. Int J Reprod Contracept Obstet Gynecol. 2016 Aug;5(8):2799-2803 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Research Article Multistep approach for control of postpartum hemorrhage in placenta accreta: a novel scheme in a tertiary referral center Ahmed Samy El-Agwany*, Tamer Mamdouh Abdeldayem INTRODUCTION Postpartum haemorrhage (PPH) is a leading cause of maternal mortality worldwide and is responsible for approximately 25% of all maternal deaths. Placental abnormalities are a major contributor to obstetric haemorrhage. The most common placental abnormalities are placental abruption, placenta previa, and an adherent (accrete, increta, or percreta). 1 Placenta accreta is one of the most serious complications of anterior placenta previa with previous lower segment caesarian delivery. Invasion of the placental tissue into the myometrium occurs with varying degree, resulting in deficient contraction of lower uterine segment and haemostasis at the placental bed. It is associated with severe obstetric haemorrhage usually necessitating hysterectomy. 2 Several methods were proposed for control of haemorrhage, with no gold standard method agreed upon yet in literature. Aim of the study was to evaluate the efficacy of lower segment plication and compression sutures at the placental bed to control bleeding in cases of placenta accreta avoiding hysterectomy. METHODS From January 2014 to January 2016, 25 women with anterior low-lying placenta and previous caesarian section(s) were recruited at El-Shatby Maternity university hospital in Alexandria, Egypt. This hospital is a tertiary center for 3 governorates in Egypt with population exceeding 10 million and caesarian section rate approaching 40% of all deliveries. This study was approved by the Ethics Committee of the hospital and a written informed consent form was signed by the women and/or their nearest relatives before the operation. Cases had previous 1-4 lower segment caesarian deliveries. Cases were diagnosed as placenta accreta by ultrasonographic examination on admission to hospital. Criteria for ultrasonographic diagnosis were: 3 Department of Obstetrics and Gynaecology, El-shatby maternity hospital, Alexandria University, Alexandria, Egypt Received: 22 June 2016 Accepted: 12 July 2016 *Correspondence: Dr. Ahmed elagwany, E-mail: ahmedsamyagwany@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Placenta accreta is a major cause for massive postpartum hemorrhage and consequent obstetric hysterectomy. Incidence is rising secondary to increased rates of caesarian delivery worldwide. Methods: From January 2014 to January 2016, 25 women with anterior low-lying placenta and previous caesarian section(s) were recruited at El-Shatby Maternity university hospital in Alexandria, Egypt. Cases had previous 1-4 lower segment caesarian deliveries. Cases were diagnosed as placenta accreta by ultrasonographic examination on admission to hospital. Elective surgery was done at 36-37 weeks. Mid line abdominal incision with upper segment uterine incision with plication of lowers uterine segment with transverse compression sutures. Results: We present a clinical trial for conservative management of placenta accreta in 25 cases with 19 cases [76%] successfully managed without hysterectomy. Conclusions: Conservative management of placenta accreta can be successfully performed in young age females desiring fertility. Keywords: Placenta, Accreta, Hysterectomy, Ultrasound, Hemorrhage DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162669