Bleeding control and posterior vaginal fornix approach for cesarean hysterectomy in placenta accreta spectrum

Abstract

Objective Placenta accreta spectrum (PAS) is a leading cause of massive obstetric hemorrhage, particularly when the placenta is removed or unintentionally disrupted during cesarean hysterectomy. In this video, we demonstrate an alternative surgical approach via the posterior vaginal fornix for performing cesarean hysterectomy in patients with PAS. Methods A cesarean hysterectomy for a case of placenta percreta was performed using the posterior vaginal fornix approach. This technique focuses on avoiding bleeding due to placental disruption and preventing urinary bladder injury. Results We summarize the steps of the procedure, including ligation of the vascular pedicles, entry into the retroperitoneal space to identify vital structures and control bleeding, dissection along avascular plane to delineate organ borders, and posterior culdotomy followed by en bloc uterine amputation to avoid urinary bladder injury and minimize blood loss. Conclusion The posterior vaginal fornix approach for cesarean hysterectomy in patients with PAS is an effective technique for minimizing bleeding from the highly vascular placental area. Additionally, it offers the advantage of reducing the risk of unintentional urinary bladder injury, thereby improving surgical outcomes in these challenging cases.