Bleeding control and posterior vaginal fornix approach for cesarean hysterectomy in placenta accreta spectrum.

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Obstetrics and Gynecology Science Pub Date : 2025-06-27 DOI:10.5468/ogs.24216

Thiti Atjimakul, Kulisara Nanthamongkolkul, Ingporn Jiamset, Yuthasak Suphasynth, Aroontorn Pichatechaiyoot, Ekasak Thiangphak, Chayut Pongpanich, Athithan Ratttanaburi

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引用次数: 0

Abstract

Objective: Placenta accreta spectrum (PAS) is a leading cause of massive obstetric hemorrhage, particularly when the placenta is removed or unintentionally disrupted during cesarean hysterectomy. In this video, we demonstrate an alternative surgical approach via the posterior vaginal fornix for performing cesarean hysterectomy in patients with PAS.

Methods: A cesarean hysterectomy for a case of placenta percreta was performed using the posterior vaginal fornix approach. This technique focuses on avoiding bleeding due to placental disruption and preventing urinary bladder injury.

Results: We summarize the steps of the procedure, including ligation of the vascular pedicles, entry into the retroperitoneal space to identify vital structures and control bleeding, dissection along avascular plane to delineate organ borders, and posterior culdotomy followed by en bloc uterine amputation to avoid urinary bladder injury and minimize blood loss.

Conclusion: The posterior vaginal fornix approach for cesarean hysterectomy in patients with PAS is an effective technique for minimizing bleeding from the highly vascular placental area. Additionally, it offers the advantage of reducing the risk of unintentional urinary bladder injury, thereby improving surgical outcomes in these challenging cases.

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胎盘增生谱剖宫产子宫切除术的出血控制及阴道后穹窿入路。

目的：胎盘增生谱（PAS）是产科大出血的主要原因，特别是当胎盘被移除或在剖宫产子宫切除术中无意中破坏时。在本视频中，我们展示了经阴道后穹窿的剖宫产子宫切除术的替代手术入路。方法：采用阴道后穹窿入路对1例percreta胎盘行剖宫产子宫切除术。这项技术的重点是避免因胎盘破裂而出血，防止膀胱损伤。结果：我们总结了手术的步骤，包括结扎血管蒂，进入腹膜后空间以识别重要结构并控制出血，沿无血管平面剥离以划定器官边界，后盲道切开术后整体子宫截肢以避免膀胱损伤和减少失血。结论：经阴道后穹窿入路行剖宫产子宫切除术是减少胎盘高血管区出血的有效方法。此外，它还提供了降低意外膀胱损伤风险的优势，从而改善了这些具有挑战性的病例的手术结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Obstetrics and Gynecology Science Medicine-Obstetrics and Gynecology

CiteScore

3.80

自引率

15.80%

发文量

审稿时长

16 weeks

期刊介绍： Obstetrics & Gynecology Science (NLM title: Obstet Gynecol Sci) is an international peer-review journal that published basic, translational, clinical research, and clinical practice guideline to promote women’s health and prevent obstetric and gynecologic disorders. The journal has an international editorial board and is published in English on the 15th day of every other month. Submitted manuscripts should not contain previously published material and should not be under consideration for publication elsewhere. The journal has been publishing articles since 1958. The aim of the journal is to publish original articles, reviews, case reports, short communications, letters to the editor, and video articles that have the potential to change the practices in women''s health care. The journal’s main focus is the diagnosis, treatment, prediction, and prevention of obstetric and gynecologic disorders. Because the life expectancy of Korean and Asian women is increasing, the journal''s editors are particularly interested in the health of elderly women in these population groups. The journal also publishes articles about reproductive biology, stem cell research, and artificial intelligence research for women; additionally, it provides insights into the physiology and mechanisms of obstetric and gynecologic diseases.