Conservative Surgery for Abnormally Invasive Placenta: A New Technique

Placental borders and mapping by ultrasonography and Doppler ultrasonography (placental mapping) preop. And verified intraoperatively . bladder peritoneal dissection till the level of internal Os Uterus is incised away from the placenta \*Baby was delivered , the uterus is exteriorised and 4-5 towel clips are applied rapidly control uterine incision site bleeding . Twenty units of diluted oxytocin and 100 to 200 cc, 37°C of heated saline were infused from here, and then the cord was clamped . Then we proceed to systemically devascularize the uterus with the placenta in site * internal iliac artery distal ligation: * broad ligament and ureteric dissection: * uterine vessels : * posterior uterine wall compression suture : * The utero-ovarian anastomosis branches are spared to keep blood flowing to the uterus. * if the bladder was not fully dissected from the anterior uterine wall , now we complete the dissection, * anterior uterine wall compression suture : * now , we excise the invaded , irreparable anterior wall segment, with the * then separation of the placenta manually * if there's still mild bleeding from the uterine placental bed another full myometrial thickness anterior or posterior uterine wall transverse sutures are applied below or above the placental bed site to control bleeding until it's deemed acceptable * in cases with separate fundal anterior incision, the high incision is repaired in layers first to give more time to compress and monitor the lower segment * refashioning of the Lower segment , repair transversely is usually done,