• DESYHANDAYANI A. F. S. Departement of Obstetrics and Gynecology, Medical Faculty, Universitas Sumatera Utara, General Hospital Haji Adam Malik Medan, Indonesia
  • MUARA P. LUBIS Feto Maternal Division, Department of Obstetrics and Gynecology, Medical Faculty, Univesitas Sumatera Utara, General Hospital Haji Adam Malik Medan, Indonesia



Conservative technique, Placenta accrete


This article review was aimed to discuss about the choices of conservative technique of placenta accrete spectrum disorder. Placenta Accreta Spectrum Disorder (PASD) is an obstetric complication complexes which tend to cause high maternal morbidity. Maternal morbidity has been reported in 60% of cases and mortality reaches 7% in women with placenta accreta. Internationally, the incidence of abnormal placental invasion has increased in the last 30 y and is currently reported to occur in 2–90 per 10,000 deliveries. Main cause of PASD is uterine surgery in particular, scars from cesarean section, a 56-fold increase in risk after three times cesarean section. In cases without massive bleeding and coagulopathy, a conservative approach can be considere. Four main conservative management methods have been described in several international literature, namely extirpative techniques (manual removal of the placenta); leaving the placenta in situ or an observative approach; one-step conservative operation (removal of the location of the accreta; and Triple-P procedure (stitching around the accretion area after resection).


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1. Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and risk factors for placenta Accreta/Increta/Percreta in the UK: a national case-control study. PLOS One 2012;7:1-7.
2. Chen L, Wang X, Wang H, Li Q, Shan N, Qi H. Clinical evaluation of prophylactic abdominal aortic balloon occlusion in patients with placenta accreta: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2019;19:30.
3. Aryananda RA. Resurgence of placenta accrete in Indonesia. Maj Obs Gin 2018;26:98-9.
4. Jauniaux E, Silver RM, Matsubara S. The new world of placenta accrete spectrum disorders. Int J Gynecol Obstet 2018;140:259-60.
5. Jauniaux ERM, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL, et al. Placenta praevia and placenta accreta: diagnosis and management. RCOG Green-Top Guideline 2018;126:1-48.
6. Thurn L, Lindqvist PG, Jakobsson M, Colmorn LB, Klungsoyr K, Bjarnadottir RI, et al. Abnormally invasive placenta–prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 2016;123:1348-55.
7. Sentilhes L, Kayem G, Chandraharan E, Palacios Jaraquemada J, Jauniaux E. FIGO consensus guidelines on placenta accrete spectrum disorders: conservative management. Int J Gynecol Obstet 2018;140:291-8.
8. Zhong L, Chen D, Zhong M, He Y, Su C. Management of patients with placenta accrete in association with fever following vaginal delivery. Medicine 2017;96:10.
9. Bartels HC, Postle JD, Downey P, Brennan DJ. Placenta accreta spectrum: a riview of pathology, molecular biology, and biomarkers. Disease Markers 2018;1-12. DOI:10.1155/2018/1507674
10. Jauniaux E, Campos DA, Roos JL, Fox KA, Collins S. FIGO classification for the clinical diagnosis of placenta accrete spectrum disorders. Int J Gynecol Obstet 2019;146:20–4.
11. Garmi G, Salim R. Epidemiology, etiology, diagnosis, and management of placenta accreta. Obstetrics Gynecol Int 2012:1-7. DOI:10.1155/2012/873929
12. Jauniaux E, Collins S, Burton GJ. Plasenta accrete spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. AJOG 2018;218:75-87.
13. Aryananda RA, Akbar A, Wardhana MP. New three dimensional/four dimensional volume rendering imaging software for detecting the abnormally invasive placenta. J Clin Ultrasound JCU 2019;47:9-13.
14. Rac MW, Dashe JS, Wells CE, Moschos E, Melntire DD, Twickler DM. Ultrasound predictors of placental invasion: the placenta accreta index. AJOG 2015;212:341-7.
15. Collins SL, Asheroft A, Braun T. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). J Int Soc Ultrasound Obstetrics Gynecol 2016;47:271-5.
16. Alfirevic Z, Tang AW, Collins SL, Robson SC, Palacios Jaraquemada J. Group of the proforma for ultrasound reporting in suspected abnormally invasive placenta (AIP). Int Consensus 2016;47:276-8.
17. Silver R. Placenta accreta syndrome. Boca Raton: CRC Press, Taylor and Francis Group; 2017.
18. Cali G, Forlani F, Lees C, Timor I, Palacios Jaraquemada J. Prenatal ultrasound staging system for placenta accreta spectrum disorders. Uktrasound Obstet Gynecol 2019;53:752-3.
19. Peiffer S, Reinhard J, Louwen F. Conservative management of placenta accreta/increta after vaginal birth. Geburtshilfe Freauenheikld 2012;72:940-4.
20. Shehata A. Uterine sparing techniques in placenta accreta. Obstet Gynecol Int J 2016;5:00143.
21. Lisa A, Jauniaux E, Hobson S, Papillon Smith J, Belfort MA. FIGO consensus guidelines on placenta accreta spectrum disorder: nonconservative surgical management. Int J Obstet 2018;140;281-90.
22. Satuan Tugas Plasenta Akreta, Kelainan Spektrum Plasenta Akreta. Kisah Warga Trenggalek Berjuang untuk Istrinya yang Idap Plasenta Akreta, ini Saran untuk Ibu Hamil. HKFM 2019;18:34.
23. Arab M, Ghavami B, Saraeian S, Sheibani S, Azar FA, Hosseini Zijpud SM. Successful management of two cases of placenta accreta and a literature review: use of the b-lynch suture and bilateral uterine artery ligation procedures. Iran Red Crescent Med 2016;18:1-4.
24. Marey DA. Outcome of stepwise uterine sparing approach as a conservative surgical management of placenta accreta. Gynecol Obstet Res Open J 2017;4:36-40.
25. Polat I, Yucel B, Gedikbasi A, Aslan H, Fendal A. The effectiveness of double incision technique in uterus preserving surgery for placenta percreta. BMC Pregnancy Childbirth 2017;17:129.
26. Chandarahan E, Rao S, Belli A, Arulkumaran S. Triple p procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. IJOG 2012;117:191-4.
27. Yen J, Yen C, Xin H. Folding sutures following tourniquet binding as a conservative surgical approach for placenta previa combined with morbidly adherent placenta. Chin Med J 2015;128:2818-20.
28. Shih JC, Liu KL, Kang J, Yang JH, Lin MW, Yu CU. ‘Nausicaa’ compression suture: a simple and effective alternative to hysterectomy in placenta accreta spectrum and other causes of severe postpartum haemorrhage. BJOG 2019;126:412–7.



How to Cite

A. F. S., D., and M. P. LUBIS. “CONSERVATIVE TECHNIQUE OF PLACENTA ACCRETA SPECTRUM DISORDER (PASD)”. International Journal of Current Pharmaceutical Research, vol. 12, no. 4, July 2020, pp. 25-28, doi:10.22159/ijcpr.2020v12i4.39094.



Review Article(s)