Complex cesarean section: Surgical approach to reduce the risks of intraoperative complications and postpartum hemorrhage.

The incidence of cesarean section is dramatically increasing worldwide, whereas the training opportunities for obstetrician/gynecologists to manage complex cesarean section appear to be decreasing. This may be attributed to changing working hours directives and the increasing use of laparoscopy for gynecological surgical procedures, including in gynecological oncology. Various situations can create surgical difficulties during a cesarean section; however, two of the most frequent are complications from previous cesarean (myometrial defects, with or without placental intrusion and peritoneal adhesions) and the high risk of postpartum hemorrhage (uterine overdistension, abnormal placentation, uterine fibroids).

[Uterine conservative treatment for placenta accreta : new standard?].

Placenta accreta spectrum (PAS) is among the most dangerous obstetric conditions due to elevated risk of massive hemorrhage. Ultrasound is PAS's preferred screening method. This article -introduces the new topographic classification of PAS, allowing for treatment selection, whether radical or conservative.

Usefulness of low-cost simulation models to learning surgical techniques for placenta accreta spectrum: An observational educational study.

Objective: To evaluate the utility of low-cost simulation models to teach surgical techniques for placenta accreta spectrum (PAS), included in a multimodal education workshop for PAS.

Methods: This was an observational, survey-based study. Participants were surveyed before and after the use of low-fidelity mannequins to simulate two surgical techniques for PAS (one-step conservative surgery [OSCS] and modified subtotal hysterectomy [MSTH]), within a multimodal educational workshop.

One-step conservative surgery vs hysterectomy for placenta accreta spectrum: a feasibility randomized controlled trial.

Background: Placenta accreta spectrum is a serious condition associated with significant maternal morbidity and even mortality. The recommended treatment is hysterectomy. An alternative is 1-step conservative surgery, which involves the en bloc resection of the myometrium affected by placenta accreta spectrum along with the placenta, followed by uterine reconstruction.

Anesthesia and postpartum pain management for placenta accreta spectrum: The patient perspective and recommendations for care.

Objective: Placenta accreta spectrum (PAS) is a high-risk complication of pregnancy, which often requires complex surgical intervention. There is limited literature on the patient experience during the perioperative period and postpartum pain management for PAS. Therefore, this study aims to explore the patient perspective of anesthesia care.

Anesthesia and postpartum pain management for placenta accreta spectrum: The healthcare provider perspective.

Objective: To explore the management and experiences of healthcare providers around anesthetic care in placenta accreta spectrum (PAS).

Methods: This descriptive survey study was carried out over a 6-week period between January and March 2023. Healthcare providers, both anesthesiologists and those involved in operative care for women with PAS, were invited to participate.

How to perform the one-step conservative surgery for placenta accreta spectrum move by move.

Background: There are 3 treatment options for placenta accreta spectrum: cesarean delivery with hysterectomy, expectant management, and uterine-sparing surgical techniques. One-step conservative surgery is the most extensively described conservative surgical technique, and it has extensive evidence supporting its usefulness; however, few groups apply it, most likely because of the misconception that it is a complex procedure that requires extensive training and is applicable to only a few patients.

Objective: This study aimed to evaluate the clinical outcomes of patients undergoing one-step conservative surgery in 4 placenta accreta spectrum reference hospitals and provided detailed steps for successfully applying this type of surgery.

Training facilitated by interinstitutional collaboration and telemedicine: an alternative for improving results in the placenta accreta spectrum.

Placenta accreta spectrum is a severe condition that requires trained, interdisciplinary group intervention. However, achieving the level of training that is required is difficult without academic programs or hospitals dedicated to teaching the necessary skills to deal with placenta accreta spectrum. We describe an interinstitutional collaboration process focused on improving placenta accreta spectrum treatment, which is facilitated by telemedicine.

Internal manual compression of the aorta-an effective way to temporarily control pelvic bleeding in obstetrical hemorrhage.

Obstetrical hemorrhage is the leading cause of maternal death, and its treatment frequently involves surgical procedures. In the most serious cases, regardless of the etiology, the priority is to stop the bleeding and obtain the conditions to definitively repair the injury that generates the bleeding. Multiple options for achieving hemostasis have been described, but most of them require extensive training or technological resources that are not available in all hospitals.

Telemedicine facilitates surgical training in placenta accreta spectrum.

Objective: The training of groups responsible for managing patients with placenta accreta spectrum (PAS) is complex because of the lack of hospitals with a high flow of patients and absence of formal educational programs. We report here the results of a virtual training program (VTP) that implemented one-step conservative surgery (OSCS).

Methods: A prospective observation study of OSCS VTP between three expert groups and PAS reference hospitals without experience in OSCS was performed.

How to identify patients who require aortic vascular control in placenta accreta spectrum disorders?

Background: The placenta accreta spectrum disorder may lead to severe complications. Helpful interventions to prevent placenta accreta spectrum bleeding include vascular control procedures in the aorta or pelvic vessels. Although these procedures are related to lower intraoperative bleeding, they are associated with complications, so the possibility of selecting patients at highest risk of bleeding while avoiding vascular procedures for all cases is attractive.

Placenta accreta spectrum: a hysterectomy can be prevented in almost 80% of cases using a resective-reconstructive technique.

Objective: To describe the use of surgical repair (One-step resective-conservative surgery) in all cases of placenta accreta spectrum.

Study Design: Multicentre retrospective case series from tertiary referral hospitals in Argentina. A total of 452 patients were accepted from 12 hospitals presenting suspicion of invasive placenta by auxiliary methods (ultrasound, Doppler and MRI).

MRI in the diagnosis and surgical management of abnormal placentation.

Objective: To determine the usefulness of placental magnetic resonance imaging (MRI) in the diagnosis and surgical management of abnormal placentation.

Design: Retrospective follow-up.

Setting: Buenos Aires, Argentina.

Efficacy of surgical techniques to control obstetric hemorrhage: analysis of 539 cases.

Objective: To analyze the efficacy of surgical techniques to stop excessive obstetric bleeding.

Design: Retrospective follow up.

Setting: Center for Medical Education and Clinical Research and a total of twelve hospitals in Buenos Aires.