Cesarean hysterectomy for placenta previa accreta, increta, and percreta: a strategic approach to minimize surgical hemorrhage.

Objective: A new approach to cesarean hysterectomy aimed at minimizing surgical hemorrhage in difficult cases of placenta previa accreta is introduced.Methods: Diagnoses of placenta percreta with bladder invasion, and of placenta increta, respectively, were made by magnetic resonance imaging in two third-trimester patients with multiple previous cesarean deliveries and symptomatic placenta previa. Elective cesarean hysterectomy was planned in both cases. A novel approach to mobilization of the bladder and lower uterine segment at cesarean hysterectomy was applied in both cases.Results: Cesarean hysterectomy by a modified approach was accomplished uneventfully in both cases. Blood loss was 900 mL and 1,100 mL respectively. Neither patient required blood component therapy.Conclusions: A novel approach to cesarean hysterectomy result was associated with limited blood loss and without the need for blood component therapy in two patients at risk for surgical hemorrhage.