[UTERINE PRESERVING METHODS FOR TREATING PLACENTA ACCRETA SPECTRUM: A PROPOSAL FOR A SURGICAL PROTOCOL].

Placenta accrete spectrum (PAS) is a complicated obstetrical condition arising from abnormal implantation of the placenta into the myometrium. The placenta might partially or completely adhere to the myometrium and in rare cases invade adjacent organs (placenta percreta). The abnormal placentation might cause life-threatening hemorrhages during pregnancy and birth, increasing maternal and neonatal mortality and morbidity. Detachment of the placenta after delivery in PAS might be difficult and requires manual removal of the placenta as well as advanced surgical procedures in more serious cases. In the past decades, several studies have demonstrated that removing the uterus while the placenta is still in situ avoided massive hemorrhage. However, in some cases, preserving the uterus and the fertility of the patient is desired and therefore advanced surgical procedures have been developed. Several techniques for uterine preserving procedures have been described: conservative management - closing the uterus while the placenta is still in situ and complementary procedures to remove the placenta, using interventional radiology to reduce the blood supply to the uterus and other surgical approaches to reduce the blood supply to the uterus. In this article we will review the different methods for uterine preserving techniques in treating advanced cases of PAS and propose a surgical protocol for such a method we use in our medical center.