Abstract
Placenta accreta spectrum (PAS) disorder often causes a large amount of intraoperative
bleeding in a short period which makes maternal circulation unstable and threatens
life. As a countermeasure, two-stage surgery combined with selective uterine arterial
embolization (UAE), named “stepwise treatment” was introduced in 2003. At a cesarean
section (CS), only the baby is delivered and the placenta is left in situ. The transcatheter
angiographic UAE is performed on the operation day, followed by the total hysterectomy
on 5 to 7 days after CS. The difficulty in the operative procedures for hysterectomy
and the amount of bleeding can be reduced by the added effect of the blood flow interruption
by UAE and the uterine involution. Although there are not many indication cases, this
is the prudent operation that should be considered for the most severe PAS case such
as total placenta increta/percreta with placenta previa.
In this article, the practical procedures and tips of stepwise treatment are described.
Keywords
placenta accreta spectrum - abnormally invasive placenta - placenta previa - modified
cesarean hysterectomy - stepwise treatment - uterine arterial embolization - catheter
occlusion
