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We describe a novel surgical technique in 31 women with histopathologically confirmed placenta accreta spectrum (PAS) disorders managed by a multidisciplinary team using a prophylactic infrarenal abdominal aortic cross-clamping technique during caesarean hysterectomy. We conclude that this new surgical procedure is a relatively safe technique to potentially control operative blood loss. Our work may stimulate others to develop protocols assessing this innovative technique to improve the surgical outcome of PAS disorders., (© 2020 John Wiley & Sons Ltd.)

Objective: Our purpose was to compare intramyometrial 15-methyl prostaglandin F2 alpha with intravenous oxytocin for controlling blood loss at elective cesarean section., Study Design: A double-blind, randomized trial was performed with intramyometrial 15-methyl prostaglandin F2 alpha, 125 micrograms, or intravenous oxytocin, 20 U, in 60 women undergoing elective lower segment cesarean section at 36 to 41 weeks' gestation. Subjective assessment of the operative blood loss and early lochial discharge and objective change in hemoglobin and hematocrit before and 24 hours after delivery and the incidence of side effects were compared by nonparametric statistical tests., Results: The mean estimated blood loss was similar in both groups, with 645 ml (SD 278, range 400 to 1500) in the 15-methyl prostaglandin F2 alpha group compared with 605 ml (SD 303, range 200 to 1750) in the oxytocin group. The mean fall in hemoglobin and hematocrit was greater in the 15-methyl prostaglandin F2 alpha group than in the oxytocin group, 0.98 gm/dl (SD 0.95) versus 0.65 gm/dl (SD 0.79) for hemoglobin and 2.58% (SD 2.96) versus 2% (SD 2.96) for hematocrit. None of these differences reached statistical significance. There were no differences in side effects and lochial discharge between the treatment groups. In both groups there was a decrease of approximately 1% in maternal arterial oxygen saturation., Conclusion: Routine intramyometrial 15-methyl prostaglandin F2 alpha, 125 micrograms, does not offer any obvious advantage over intravenous oxytocin, 20 U, in reducing operative blood loss at elective lower-segment cesarean section.

Among several surgical techniques for the aforementioned conditions, the first strategy is a primary caesarean hysterectomy and partial cystectomy for scenario 1 and an extended hysterectomy with radical parametrectomy procedure for scenario 2. Authors' response Re: Some concerns regarding aortic cross-clamping in caesarean hysterectomy for placenta accreta spectrum (Re: Vascular control by infrarenal aortic cross-clamping in placenta accreta spectrum disorders: description of technique; something old, something new & something borrowed) I Sir, i We thank Matsubara and Fox for their insightful comments1,2 on our article.3 We agree with their point that the infrarenal aortic cross-clamping technique for placenta accreta spectrum (PAS) disorder ideally should be evaluated by well-designed, high-quality, prospective randomised controlled studies. [Extracted from the article]

Balloon occlusion of the infrarenal abdominal aorta theoretically provides the same level of pelvic perfusion blockage as our approach.3 A major disadvantage of this procedure is that the catheter must be placed before commencing the surgery,3 which may not be possible if a prenatal diagnosis of PAS disorder has not been made. I Sir, i We thank Nieto-Calvache et al. for their insightful comments1 on our article.2 We agree with their point that the choice of vascular control techniques should be determined by the topography and severity of placenta accreta spectrum (PAS) disorders. Authors' reply re: Vascular control by infrarenal aortic cross-clamping in placenta accreta spectrum disorders: description of technique. [Extracted from the article]