HYSTERECTOMY

IN PLACENTA ACCRETA

Gatot Purwoto

Division Gynecology oncology

MedicaL Faculty univERSITY of indonesia
Ciptomangunkusumo hospital

BIENNIAL MEETING INASGO

NOVEMBER 13TH, 132021
 Bleeding Risk in Placenta Accreta

• SC in placenta accreta sometime may causes serious

complication or fatal
• Most of cases needed to perform planned
hysterectomy, and some unpredictably hysterectomy
• Need good pre-op-evaluation & blood preparation
• Could be anticipated by skill-surgical procedure
 Basic surgical Treatment

• Dissection & local hemostasis

• Devascularization control:
• Hypogastric artery ligation
• Combine with Uterine artery Ligation
• Or even temporary Infrarenal Aorta Ligation
• If could not be controlled or diffuse bleeding àabdominal
tamponade or mechanical compression (gauze)
• Medical support treatment à Antifibrinolytic
Most Indication of Obstetrics Hysterectomy

J Obstet Gynecol India Vol. 55, No. 2 : March/April 2005

Abdomen & Pelvic Vascularization
Arteries & Ureter
Arteries & Veins
Collaterale system of the arteries
of the internal genital organs
 Hypogastric Artery Ligation

Open retroperitoneally
at the lateral pelvic
nearby befurcation of
external & internal iliac
artey

Identify ureter

Use any kind suturing

material
 Infra-renal Aorta Ligation
Open retroperitoneally

Location of infra renal

Aorta

Temporary ligation

Using elastic rubber

material (etilope)
 Intraabdominal Gauze Tamponade

Uncontrol diffuse bleeding

Compressed some rolls of

gauze intrapelvic-
abdominal cavity

Remove it after 24 hour

(if stable condition)
Type of Abdmoninal Hysterectomy
Hysterectomy in Placenta Accreta
VIDEO SC HISTERECTOMY
 Take Home Messages

• Histerectomy still remains a common procedure for

bleeding control in SC with placenta accreta
• Should be wiseful to decide and choose technical
approach of hysterectomy in time before the patient's
condition further deteriorates
• Knowledge and skill of operation is needed to perform
bleeding risk hysterectomy to save lives in catastrophic
conditions
VIDEO SC HISTERECTOMY
TERIMA KASIH