Cesarean hysterectomy

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Definitive diagnosis of placenta accreta, increta, and percreta cannot be made until after delivery and a tentative diagnosis of accreta is usually not made until the third trimester; however, clinicians are able to identify patients at risk early in the pregnancy. Placenta percreta describes invasion through the myometrium and serosa, and occasionally into adjacent organs, such as the bladder. When placenta percreta is complicated by bladder invasion (incidence of 0.3 to 1 per 10,000 births), mortality rates have been estimated as high as 9.5% and 24% for mother and child, respectively. Developing the Vesicouterine space early in the operation using the conventional midline way of caesarean hysterectomy provokes immediate haemorrhage, and therefore the timing and technique of this step were the focus of our surgical plan. The main improvement of this technique compared with standard hysterectomy, is the cephalad blunt dissection of the bladder (which can be invaded), moving away from the trigone level, once the uterus is completely devascularised.

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