Up-front dissection of the uterovesical space or “bladder-first approach” reduces hemorrhage and bladder injury during hysterectomy for placenta accreta spectrum: reconfirmed in 78 more cases in a prospective single-center study

作者：Pradip Kumar Saha, Rashmi Bagga, Rimpi Singla, Aashima Arora, Vanita Jain, Vanita Suri, Kajal Jain, Parveen Kumar, Nalini Gupta, Ashish Jain, Tulika Singh, Ravimohan S. Mavuduru · 发表于：AJOG Global Reports · 年份：2024 · DOI：10.1016/j.xagr.2024.100425 · 被引用次数：2 · 研究领域：Maternal and fetal healthcare、Pregnancy and preeclampsia studies、Vascular Anomalies and Treatments

BACKGROUND: Cesarean hysterectomy for placenta accreta spectrum disorder may be associated with severe hemorrhage because of placental invasion of the myometrium and the uterovesical space or parametrium. It leads to serious complications, such as massive hemorrhage requiring massive transfusion, coagulopathy, bladder and ureteric injuries, need for intensive care unit admission and prolonged hospital stay. To reduce the complications of cesarean hysterectomy for placenta accreta spectrum disorder, ongoing efforts are being made to develop different surgical approaches. In previous 12 cases upfront dissection of uterovesical space (bladder-first approach) before delivery of the neonate was observed to reduce hemorrhage arising from extensive neovascularization in this area and bladder injury. OBJECTIVE: This study aimed to assess the efficacy of the bladder-first approach in a large sample to reduce the complications of cesarean hysterectomy for placenta accreta spectrum disorder. STUDY DESIGN: This study presented data of 78 women (2017-2022) who underwent cesarean hysterectomy for placenta accreta spectrum disorder using the "bladder-first approach" from a tertiary care institute in Chandigarh, India. In this surgical approach, dissection of the uterovesical fold from the lower uterine segment to the cervix was performed before making the uterine incision for delivery. During this dissection, vascular areas were isolated and coagulated with bipolar electrosurgery or ligated...