DARIP Technique: A Novel Approach in the Surgical Management of Placenta Accreta Spectrum in the Second Trimester From Tu Du Hospital, Vietnam.

Abstract

Background: Placenta accreta spectrum (PAS) is an increasingly common complication during pregnancy that has led to high maternal mortality and morbidity in the past decades. Treatment of PAS in the second-trimester pregnancy includes expectant management and surgical intervention. However, PAS surgery is related to complex obstetric management involving psychological issues and life-threatening hemorrhage. In low- and middle-income countries, cesarean delivery, along with uterine-sparing surgery in pregnancies complicated by PAS disorders, could be an optimal choice due to limited resources.

Methods: Herein, we describe a novel procedure in managing PAS in the second trimester of gestation through a clinical case and presentation of a video.

Case presentation and results: The 35-year-old pregnant woman at term of 21 weeks and 6 days was hospitalized due to important vaginal bleeding. An ultrasound scan revealed PAS type percreta. The patient was managed with the DARIP procedure. The surgical approach included five steps: (1) Dissection of the uterovesical interface containing newly proliferative vessels, (2) Amniotic fluid reduction, (3) Rectangular-shaped hemostatic sutures, (4) Incision of the uterine layer through the vascular-blocked region, and (5) Precise suturing of the placental bed. Regarding surgical outcomes, the estimated blood loss was 300 mL, and no surgical complication was noted. The patient was sent home on Day 7.

Conclusions: The DARIP procedure is a promising method in managing PAS disorders in the second trimester. However, the DARIP technique requires further validation in larger studies. Moreover, this feasible procedure should be performed at an expert center to optimize the maternal outcomes.