Placenta increta and minimally invasive surgery: our experience and narrative review of the literature

ABSTRACT

Background. Placenta accreta spectrum disorder is a rare condition with a prevalence rate of 0.01-1.1%, increasing in incidence over the last years. It is a pathology that puts fetal life at risk, but above all maternal life. Accurate prenatal diagnosis, a multidisciplinary approach, the presence of skilled laparoscopic surgeons, appropriate equipment, resources and a tertiary hospital setting are key factors for successful management

Case presentation. We present the case of a 33-year-old woman with a complex medical history. She has undergone various surgical procedures, including a complicated myomectomy with haematoma and infection, cholecystectomy, appendectomy, and sleeve gastrectomy.

Following a spontaneous delivery, she developed primary and secondary postpartum haemorrhage. The patient required uterine tamponade at the delivery hospital and subsequent uterine artery embolization at another centre, followed by total hysterectomy with bilateral salpingectomy and abdominopelvic adhesiolysis at our institution. The surgical procedure revealed a residual placenta with pathological adhesion and myometrial invasion, confirming the diagnosis of placenta accreta spectrum disorder (PASD). She was discharged in good general condition.

A laparoscopic approach can be considered for delayed surgical management of this condition, even in patients with severe puerperal haemorrhage and hypovolemic shock. This strategy, with its potential to reduce morbidity, represents a compromise between postpartum hysterectomy and conservative management

Conclusions. The use of mini-invasive laparoscopic techniques for the performance of total hysterectomy in PASD is possible, reduces the haemorrhagic risk during the intervention, improves the outcome and postoperative pain, with the final result of reducing the days of Hospitalization.