Background
Placenta accreta spectrum (PAS) is a severe obstetric disorder that requires extensive resources and multidisciplinary expertise. In many European centers, low case numbers and the absence of structured training programs limit opportunities to adopt conservative surgical techniques. At present, there is no consensus on the optimal management of PAS.
Case presentation
We describe the first experience with uterine-sparing surgery for PAS in a Lithuanian tertiary center, developed through collaboration with Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili (Cali, Colombia). Between April and September 2024, four women with antenatally suspected PAS (two increta, two accreta) were treated with one-step conservative surgery (OSCS). Teleconsultation supported each stage of care, including ultrasound review, joint surgical planning, intraoperative assistance, and postoperative debriefing. All four patients recovered without major complications, and neonatal outcomes were favourable. For comparison, outcomes from nine women managed with cesarean hysterectomy between 2022 and 2023 were reviewed.
Conclusion
This case series demonstrates that uterine-sparing surgery can be safely introduced in a low-volume setting with structured teleconsultation support. International collaboration provides a practical framework for surgical training and may facilitate broader adoption of conservative PAS management.
Keywords: Placenta accreta spectrum, Uterine-sparing surgery, Conservative management, Telemedicine, Ultrasound staging
Plain Language Summary
Placenta accreta spectrum (PAS) is a dangerous pregnancy complication where the placenta attaches too deeply to the uterus. It can cause heavy bleeding at birth, and in many hospitals, the usual treatment is hysterectomy (removal of the uterus), which ends the chance of future pregnancies.
In this report, doctors in Lithuania collaborated with a team of international experts in Colombia, utilizing teleconsultation to share ultrasound images, plan surgeries together, and receive live support during operations. Four women with PAS were treated with uterus-preserving surgery instead of hysterectomy, and both mothers and babies had good outcomes.
This experience shows that international collaboration through telemedicine can help hospitals safely adopt new surgical techniques, giving women with PAS a chance to avoid hysterectomy and preserve fertility when carefully selected and supported.
Background
Placenta accreta spectrum (PAS) describes abnormal adherence of the placenta to the myometrium, most often at sites of uterine scarring. The strongest risk factors are placenta previa and previous cesarean delivery [1]. With the global rise in cesarean rates, PAS has become increasingly common and remains one of the leading causes of obstetric hemorrhage and maternal mortality [2].
The most widely accepted treatment is cesarean hysterectomy with the placenta left in situ after delivery [1]. While effective, this approach is associated with massive transfusion, prolonged surgery, bladder injury, and the need for intensive care [3]. Uterus-preserving options, such as one-step conservative surgery (OSCS) or MOSCUS have been proposed for selected patients; however, their adoption is limited in many European hospitals due to low case volumes and a lack of structured training programs [4–6]. There are many reasons to preserve the uterus in PAS. Patients may request it, there may be a desire for future pregnancy, but the most important reason is that it is not always necessary to remove the uterus. OSCS is as safe and effective as a hysterectomy for treating PAS. If the lesion involves the upper uterine segment (types 1 or 0), OSCS appears to be associated with shorter operating times and fewer transfusions [7, 8]. There are numerous reports on the safety of different uterine-preserving techniques [9]. The most frequently described is OSCS, and many modifications of this technique also exist [6]. In almost all reports, conservative techniques are described as safe when the patient is appropriately selected based on intraoperative staging [9, 10].
Teleconsultation has emerged as a practical tool to address these challenges. Remote collaboration allows standardized ultrasound review, structured surgical planning, intraoperative guidance, and postoperative debriefing, helping local teams build competency [10, 11]. Prior studies have shown that tele-assistance can facilitate safe adoption of conservative PAS management even in low-resource or low-volume centers [11–15].
In this case series, we report the first four PAS patients managed with OSCS at a tertiary Lithuanian center through real-time teleconsultation with an expert team in Colombia. We also compare these outcomes with a historical cohort of women managed by cesarean hysterectomy with iliac artery balloon occlusion.
Uterine-sparing surgery can be achieved in selected PAS cases when guided by structured ultrasound staging and intraoperative evaluation, with teleconsultation support from experienced referral centers. Teleconsultation enables safe adoption of uterine-sparing surgery for placenta accreta spectrum in hospitals where hysterectomy has been the only management option.
Case presentation
Between April and September 2024, four women with antenatally suspected PAS (two placenta increta, two placenta accreta) were referred to the Lithuanian University of Health Sciences Hospital, Kaunas. All had a history of cesarean delivery and placenta previa. Patients provided informed consent for international collaboration, data sharing, intraoperative teleconsultation, and recording of their data. The regional bioethics committee approved the study (Approval No. BE-2-20; April 18, 2025) and the study was conducted in accordance with the Declaration of Helsinki.
Workflow and teleconsultation process (Table 1)
Table 1.
Teleconsultation workflow for individualized PAS surgical planning using topographic classification
| Step | Local team activity | Objective of teleconsultation with remote PAS team |
|---|---|---|
| 1 | Approval of collaboration | Support during adoption of unfamiliar surgical skills; consideration of institutional regulations |
| 2 | Patient informed consent | Ensure patient autonomy, privacy, and safety |
| 3 | Protocolized ultrasound (6 clips + 4 images) | Remote asynchronous review; joint virtual planning (plans A, B, C) |
| 4 | Local presurgical planning | – |
| 5 | Opening of broad ligament | Identify lateral uterine wall involvement |
| 6 | Exploration of paravesical space | Support in identifying retrovesical dissection plane |
| 7 | Digital exploration of retrovesical space (Pelosi maneuver) | Assistance in identifying fibrotic tissue between bladder and uterus |
| 8 | Retrovesical dissection with vesicouterine pedicle ligation | Support in exposing anterior uterine wall and healthy myometrium |
| 9 | Fetal delivery via transverse incision (Ward maneuver) | Joint identification of safe incision site |
| 10 | Exteriorization of uterus, final staging | Remote support in confirming surgical plan |
| 11 | Execution of selected procedure | Remote team on standby for queries |
| 12 | Postoperative debriefing | External audit, feedback, and identification of improvements |
PAS placenta accreta spectrum
Management followed a structured teleconsultation pathway:
-
Approval and preparation – Collaboration with the Colombian team was established, respecting institutional and regulatory frameworks.
Initial surgical training and education were conducted from January 2024. Weekly online meetings were held over six months to disseminate the specific details of the study and to review real PAS clinical cases, illustrating the management proposed for each category based on the topographic classification. Those recording meetings are available on YouTube (https://www.youtube.com/@PAStopographyofficial/videos).
After online meetings, collaboration between institutions continues through virtual training activities focused on ultrasound staging, surgery staging and conservative surgery. After completing four supervised procedures of OSCS, we maintained virtual interactions as needed and, once we had mastered the interventions included in ultrasound and operation staging of PAS, routinely performed auditing and supervisory activities for each patient. Also, our team was in an on-site meeting and received hands-on training on the simulation models in Utrecht.
Informed consent – Patients were counseled on the role of telemedicine and its implications for privacy and safety.
Ultrasound staging – Standardized transabdominal and transvaginal ultrasound (six video clips, four static images) was performed according to published tele-ultrasound recommendations [8]. De-identified pictures and schematic diagrams were shared for asynchronous review. We can state that PAS was diagnosed preoperatively following previously reported criteria [12] and the diagnosis was confirmed by gross analysis of the resected surgical specimen, confirming that the myometrium does not detach from the placenta.
Joint surgical planning – Local and remote teams held virtual meetings to define surgical strategies and backup options.
-
Intraoperative support – Teleconsultation was maintained throughout surgery, including staging, bladder dissection, and identification of safe incision sites.
The same group of surgeons performed all the first four cases of OSCS; the team consisted of a maternal-fetal-medicine specialist and two oncogynecologists, who are familiar with the oncogynecology surgeries and participated in online meetings and hands-on simulation.
Postoperative debriefing – Cases were reviewed jointly to identify strengths and opportunities for improvement.
Surgical management
All patients underwent planned delivery at 36–37 weeks after multidisciplinary evaluation, except one who required earlier intervention for recurrent bleeding. Surgeries began under regional anaesthesia; two required conversions to general anaesthesia due to intraoperative pain. 2 g of Cefazolin i/v as antibiotic prophylaxis was used in all cases before the skin incision. A wide Pfannenstiel incision was used, followed by bladder dissection and surgical staging with the PAS topographic classification [7]. Lesions were confirmed intraoperatively: two high anterior (type 1) and two low anterior (type 3) (Figs. 1, 2, 3, and 4).
Fig. 1.
A – Transvaginal ultrasound (US TV) at the third trimester of pregnancy, 2D US showing placental bulge, colour Doppler US showing bridging vessels (white small arrows) and placental lacunae (white symbol) ; B – the opening of the abdomen shows an anterior uterine wall with a placental bulge; C – telemedicine during the surgery; D – reconstructed the anterior uterine wall
Fig. 2.
A – anterior uterine wall showing neovascularisation; B – Transvaginal ultrasound (US TV) colour Doppler showing bringing vessels (white small narrows); C – uterus after fetus extraction, showing uterine tourniquet for bleeding control (white arrow); D – restored uterine wall after excision of anterior uterine part with PAS area
Fig. 3.
A – Transvaginal ultrasound (US TV) at the third trimester of pregnancy, placenta praevia anterior, colour Doppler US showing uterovesical hypervascularity (two white arrows); B – Transabdominal ultrasound (US TA) colour Doppler showing lacunae feeding vessel; C – dissection of the bladder; D – reconstructed anterior uterine wall
Fig. 4.
A – Transvaginal ultrasound (US TV) placenta praevia anterior colour doppler US showing hypervascularisation of the placenta; B – US TV the thickness of the placenta bed and bulging; C – anterior uterine wall during the surgery – neovascularisation and bladder dissection; D – uterine wall reconstruction
OSCS was achieved in all four cases. A uterine tourniquet was applied to reduce blood loss during en bloc resection of the affected uterine wall (Fig. 2 C). Operative times ranged from 81 to 155 min, and blood loss from 1300 to 3000 mL. Objective quantification of blood loss was used, including the weight of compresses and surgical gowns, the amount collected in the suction devices. This article describes the quantification [16]. Three women required transfusion of packed red blood cells. One patient sustained a 2 cm bladder injury, which was repaired intraoperatively. Postoperative hospital stay ranged from 5 to 11 days. No infection complications occurred after the surgery.
Neonatal outcomes were favourable, with a mean birth weight of 3118 g and Apgar scores of 9–10. Histopathology confirmed two cases of placenta increta and two of accreta. All patients received postoperative thromboprophylaxis and oral iron therapy (Table 2).
Table 2.
Demographic, obstetric characteristics, and primary outcomes of four PAS patients managed with uterine-sparing surgery
| Characteristic / Outcome | Case 1 | Case 2 | Case 3 | Case 4 |
|---|---|---|---|---|
| Age (years) | 38 | 36 | 42 | 33 |
| Previous cesarean sections | 3 | 2 | 2 | 2 |
| Gestational age at delivery (weeks + days) | 37 + 4 | 37 + 1 | 36 + 2 | 36 + 3 |
| Duration of surgery (min) | 155 | 103 | 81 | 107 |
| Anesthesia | Regional → converted | Regional → converted | Regional | Regional |
| Intraoperative blood loss (mL) | 3000 | 2000 | 1300 | 2100 |
| PRBC transfusion (units) | 4 | 2 | 0 | 2 |
| Surgical complication | Bladder injury (2 cm) | – | – | – |
| Postpartum hospital stay (days) | 11 | 5 | 6 | 8 |
| Birth weight (g) | 3450 | 3125 | 2575 | 3325 |
| Apgar score at 5 min | 10 | 10 | 9 | 10 |
| Histopathology | Placenta increta | Placenta increta | Placenta accreta | Placenta accreta |
CS cesarean section, PAS placenta accreta spectrum, PRBC packed red blood cells
Comparison with the historical cohort
For context, outcomes from nine women with intraoperatively and histologically confirmed PAS who underwent cesarean hysterectomy with or without iliac artery balloon occlusion between April 2022 and April 2023 were reviewed. Demographics, intraoperative findings, and postoperative morbidity were compared (Table 3).
Table 3.
Demographic, obstetric characteristics, and clinical outcomes of PAS patients managed with hysterectomy versus OSCS
| Variable | Total (n = 13) | Hysterectomy (n = 9) | OSCS (n = 4) |
|---|---|---|---|
| Maternal age (years) | 36.1 (28–42) | 35.6 (28–41) | 37.2 (33–42) |
| Previous cesarean sections, n (%) | 1: 3 (23%)2: 7 (54%)3: 2 (15%) | 1: 3 (33%)2: 4 (44%)3: 1 (11%) | 1: 02: 3 (75%)3: 1 (25%) |
| Previous curettage, n (%) | 1: 5 (38%)2: 03: 1 (8%) | 1: 5 (56%)2: 03: 1 (33%) | 0 |
| Diagnostic method, n (%) | US: 7 (54%)US + MRI: 5 (38%) | US: 3 (33%)US + MRI: 5 (56%) | US: 4 (100%) |
| Gestational age at birth (weeks) | 35.4 (32–37) | 35 (32–37) | 36.5 (36–37) |
| Antepartum bleeding, n (%) | 4 (31%) | 3 (33%) | 1 (25%) |
| Planned CS, n (%) | 12 (92%) | 8 (89%) | 4 (100%) |
| Apgar score at 5 min | 8.4 (3–10) | 7.8 (3–10) | 9.8 (9–10) |
| Intraoperative blood loss (mL) | 2531 (1000–4500) | 2722 (1500–4500) | 2100 (1300–3000) |
| Incision type, n (%) | Vertical: 9 (69%)Transverse: 4 (31%) | Vertical: 9 (100%) | Transverse: 4 (100%) |
| Duration of surgery (min) | 122 (81–155) | 127 | 111 |
| Hospital stay (days) | 8.6 (4–16) | 9.2 (4–16) | 7.5 (5–11) |
| RBC transfusion, n (%) | 9 (69%) | 6 (67%) | 3 (75%) |
| RBC units transfused | 2.3 (0–6) | 3.6 (2–6) | 2.1 (0–4) |
| Anesthesia type, n (%) | Neuraxial: 2 (15%)Neuraxial→GA: 2 (15%)GA: 9 (69%) | GA: 9 (100%) | Neuraxial: 2 (50%)Neuraxial→GA: 2 (50%) |
| Vascular interventions, n (%) | None: 6 (46%)IIA occlusion: 6 (46%) | None: 2 (22%)IIA occlusion: 6 (66%) | None: 4 (100%) |
| Surgical reintervention, n (%) | 1 (8%) | 1 (11%) | 0 |
CS cesarean section, OSCS one-step conservative surgery, PAS placenta accreta spectrum, US ultrasound, MRI magnetic resonance imaging, RBC red blood cells, GA general anesthesia, IIA internal iliac artery
Discussion
This case series describes the successful introduction of uterine-sparing surgery for PAS in Lithuania, supported by intercontinental teleconsultation. To our knowledge, these were the first OSCS procedures with uterine reconstruction performed in our country. All four women achieved favorable maternal and neonatal outcomes, demonstrating that conservative PAS management can be safely adopted in low-volume centers when structured collaboration is in place. According to previous studies, conservative surgery in pregnancies complicated by PAS does not seem to increase the risk of adverse neonatal outcomes [17]. Risk factors, associated with neonatal complications were earlier gestational age or emergency cesarean delivery [17, 18]. In a previous study, no cases of placenta previa or PAS were observed in a cohort of 202 patients after conservative surgery [19].
Conservative techniques provide several advantages compared with hysterectomy [20]. Beyond preserving fertility, they may reduce transfusion requirements, surgical duration, and postoperative morbidity, particularly for lesions located on the upper anterior uterine wall [7, 9]. In our series, operative times and intraoperative blood loss were comparable to those reported by experienced referral centers, despite our lack of prior hands-on experience with OSCS.
Central to this success was the use of topographic classification during both ultrasound and surgery. This system clarifies the extent of placental invasion, guides incision placement, and helps identify vascular territories at risk [10]. By staging both preoperatively and intraoperatively, teams can make real-time decisions about whether a conservative approach is safe and feasible, while avoiding unnecessary blood loss.
Our findings align with earlier reports highlighting the value of telemedicine in PAS management. In hospitals performing their first conservative cases, tele-assistance has been associated with similar operative times and blood loss as experienced centers [11]. Even when PAS is undiagnosed before delivery, intraoperative teleconsultation has been shown to improve outcomes by helping teams identify safe surgical planes [2, 13]. These experiences reinforce the role of global surgery principles in promoting collaboration between high-volume referral units and centers managing only a few PAS cases each year [21–23].
The main limitation of our study is the small sample size and retrospective comparison with a historical cohort of hysterectomy cases. Another point is that, in a historical cohort, surgeries performed by different teams could introduce bias into outcomes. Nonetheless, this is the first report from Lithuania to document outcomes of PAS managed with OSCS and to illustrate how international teleconsultation can facilitate the introduction of complex surgical techniques.
Conclusion
Early diagnosis, structured preoperative planning, and multidisciplinary collaboration remain essential for safe PAS management. Our experience shows that teleconsultation can enable hospitals with limited exposure to PAS to transition from hysterectomy as the only available option to individualized, uterus-preserving surgery in selected patients. Wider adoption of this approach could expand access to fertility-preserving treatment while maintaining patient safety in diverse clinical settings.
Acknowledgements
We are grateful to the patients and their families for consenting to share their experiences. We thank the multidisciplinary teams at the Lithuanian University of Health Sciences Hospital and Fundación Valle del Lili, Cali, Colombia, for their collaboration and dedication.
Authors’ contributions
- **Conceptualization: ** [E.S.], [A.J.N-C]- **Methodology: ** [E.S.], [J.M.P-J], [A.J.N-C]- **Ultrasound evaluation and staging: ** [E.S.], [A.J.N-C]- **Surgical management: ** [E.S.], [M.K.], [J.B.], [E.Sv.]- **Teleconsultation support: ** [A.J.N-C]- **Data curation: ** [E.S.], [J.B.]- **Formal analysis: ** [E.S.]- **Writing – original draft: ** [E.S.], [J.M.P-J]- **Writing – review & editing: ** [E.S.], [M.K.], [J.M.P-J], [A.J.N-C]- **Supervision: ** [A.J.N-C] All authors read and approved the final manuscript.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Data availability
All data generated or analyzed during this case series are included in this published article and its supplementary information files. Additional details are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
Ethical approval for this study was obtained from the Regional Bioethics Committee at the Lithuanian University of Health Sciences (Approval No. BE-2-20; April 18, 2025) and the study was conducted in accordance with the Declaration of Helsinki. All patients provided written informed consent to participate in the study and to have their data used for research and publication purposes.
Consent for publication
Written informed consent for publication of clinical details and images was obtained from all participating patients. Copies of the consent forms are available for review by the Editor of this journal.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Jauniaux E, Aplin JD, Fox KA, Afshar Y, Hussein AM, Jones CJP et al. Placenta accreta spectrum. Nat Rev Dis Primers. 2025;11(1):40. 10.1038/s41572-025-00624-3. PMID: 40473652. [DOI] [PubMed]
- 2.Morlando M, Collins S. Placenta accreta spectrum disorders: challenges, risks, and management strategies. Int J Womens Health. 2020;12:1033–45. 10.2147/IJWH.S224191. PMID: 33204176; PMCID: PMC7667500. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Aryananda RA, Nieto-Calvache AJ, Duvekot JJ, Aditiawarman A, Rijken MJ. Management of unexpected placenta accreta spectrum cases in resource-poor settings. AJOG Glob Rep. 2023;3(2):100191. 10.1016/j.xagr.2023.100191. PMID: 37168547; PMCID: PMC10165260. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Einerson BD, Gilner JB, Zuckerwise LC. Placenta accreta spectrum. Obstet Gynecol. 2023;142(1):31–50. 10.1097/AOG.0000000000005229. Epub 2023 Jun 7. PMID: 37290094; PMCID: PMC10491415. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Brown AD, Hart JM, Modest AM, Hess PE, Abbas AM, Nieto-Calvache AJ, et al. Geographic variation in management of patients with placenta accreta spectrum: an international survey of experts (GPASS). Int J Gynaecol Obstet. 2022;158(1):129–36. 10.1002/ijgo.13960. Epub 2021 Oct 28. PMID: 34610154. [DOI] [PubMed] [Google Scholar]
- 6.Thi Pham XT, Bao Vuong AD, Vuong LN, Nguyen PN. A novel approach in the management of placenta accreta spectrum disorders: A single-center multidisciplinary surgical experience at Tu Du Hospital in Vietnam. Taiwan J Obstet Gynecol. 2023;62(1):22–30. 10.1016/j.tjog.2022.09.003. PMID: 36720545. [DOI] [PubMed]
- 7.Nieto-Calvache AJ, Palacios-Jaraquemada JM, Aryananda R, Basanta N, Aguilera R, Benavides JP et al. How to perform the one-step conservative surgery for placenta accreta spectrum move by move. Am J Obstet Gynecol MFM. 2023;5(2):100802. 10.1016/j.ajogmf.2022.100802 . Epub 2022 Nov 11. PMID: 36372188. [DOI] [PubMed]
- 8.Nieto-Calvache AJ, Benavides-Calvache JP, Aryananda R, Palacios-Jaraquemada JM, Jauniaux E, Fox KA et al. Telemedicine ultrasound assessment for placenta accreta spectrum: utility and interobserver reliability of asynchronous remote imaging review. Int J Gynaecol Obstet. 2024. 10.1002/ijgo.15991. Epub ahead of print. PMID: 39487689. [DOI] [PubMed]
- 9.Pinto PV, Freitas G, Vieira RJ, Aryananda RA, Nieto-Calvache AJ, Palacios-Jaraquemada JM. Placenta accreta spectrum disorder: A systematic review and meta-analysis on Conservative surgery. Int J Gynecol Obstet. 2025;00:1–22. 10.1002/ijgo.70322. [DOI] [PubMed] [Google Scholar]
- 10.Palacios-Jaraquemada JM, Basanta N, Nieto-Calvache Á, Aryananda RA. Comprehensive surgical staging for placenta accreta spectrum. J Maternal-Fetal Neonatal Med. 2022;35(26):10660–6. 10.1080/14767058.2022.2154572. [DOI] [PubMed] [Google Scholar]
- 11.Nieto-Calvache AJ, Palacios-Jaraquemada JM, Aguilera LR, Arriaga W, Colonia A, Aryananda RA, et al. Telemedicine facilitates surgical training in placenta accreta spectrum. Int J Gynaecol Obstet. 2022;158(1):137–44. 10.1002/ijgo.14000. Epub 2021 Nov 20. PMID: 34714947. [DOI] [PubMed] [Google Scholar]
- 12.Jauniaux E, Bhide A, Kennedy A, Woodward P, Hubinont C, Collins S. For the FIGO placenta accreta diagnosis and management expert consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: prenatal diagnosis and screening†,‡. Int J Gynecol Obstet. 2018;140:274–80. [DOI] [PubMed] [Google Scholar]
- 13.Nieto-Calvache AJ, López-Girón MC, Nieto-Calvache AS. The usefulness of inter-institutional collaboration (teleconsultation, eHealth) in the management of placenta accreta. J Matern Fetal Neonatal Med. 2022;35(6):1081–7. Epub 2020 Mar 22. PMID: 32202177. [DOI] [PubMed] [Google Scholar]
- 14.Nieto-Calvache AJ, Palacios-Jaraquemada JM, Hidalgo A, Vergara-Galliadi LM, Cortés Charry R, Aguilera Daga LR, et al. Management practices for placenta accreta spectrum patients: a Latin American hospital survey. J Matern Fetal Neonatal Med. 2022;35(25):6104–11. Epub 2021 Mar 22. PMID: 33813963. [DOI] [PubMed] [Google Scholar]
- 15.Metaxas T, Garcia Vilaplana E, Peter-Berner C, Palacios-Jaraquemada JM, Nieto-Calvache AJ, De Martinez B et al. Préservation utérine pour le placenta accreta: nouveau standard? [Uterine conservative treatment for placenta accreta: new standard?]. Rev Med Suisse. 2024;20(891):1856-61. French. 10.53738/REVMED.2024.20.891.1856. PMID: 39429172. [DOI] [PubMed]
- 16.Begum F, Nieto-Calvache AJ, Schlembach D, et al. FIGO recommendations on objective measurement of blood loss after birth for early detection of postpartum hemorrhage. Int J Gynecol Obstet. 2025;00:1–18. 10.1002/ijgo.70523. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Palacios-Jaraquemada JM, Basanta N, Fiorillo A, Labrousse C, Martínez M. Neonatal outcome after conservative-reconstructive surgery for placenta accreta spectrum disorders. J Maternal-Fetal Neonatal Med. 2021;35(25):4994–6. 10.1080/14767058.2021.1873944. [DOI] [PubMed] [Google Scholar]
- 18.Nguyen PN, Vuong ADB, Pham XTT. Neonatal outcomes in the surgical management of placenta accreta spectrum disorders: a retrospective single-center observational study from 468 Vietnamese pregnancies beyond 28 weeks of gestation. BMC pregnancy childbirth. 2024;24:228 10.1186/s12884-024-06349-7 [DOI] [PMC free article] [PubMed]
- 19.Palacios-Jaraquemada JM, Basanta N, Labrousse C, Martínez M. Pregnancy outcome in women with prior placenta accreta spectrum disorders treated with conservative-reconstructive surgery: analysis of 202 cases. J Maternal-Fetal Neonatal Med. 2021;35(25):6297–301. 10.1080/14767058.2021.1910671. [DOI] [PubMed] [Google Scholar]
- 20.Nieto-Calvache ÁJ, Aryananda RA, Palacios-Jaraquemada JM, Cininta N, Grace A, Benavides-Calvache JP, et al. One-step Conservative surgery vs hysterectomy for placenta accreta spectrum: a feasibility randomized controlled trial. Am J Obstet Gynecol MFM. 2024;6(6):101333. Epub 2024 Mar 6. PMID: 38458362. [DOI] [PubMed] [Google Scholar]
- 21.Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569–624. 10.1016/S0140-6736(15)60160-X. Epub 2015 Apr 26. PMID: 25924834. [DOI] [PubMed] [Google Scholar]
- 22.Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):e005671. 10.1136/bmjgh-2021-005671. PMID: 34130991; PMCID: PMC8208001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Palacios-Jaraquemada JM, Nieto-Calvache ÁJ, Aryananda RA, Basanta N. Advantages of individualizing the placenta accreta spectrum management. Front Reprod Health. 2023;4:1096175. 10.3389/frph.2022.1096175. PMID: 36685091; PMCID: PMC9853884. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
All data generated or analyzed during this case series are included in this published article and its supplementary information files. Additional details are available from the corresponding author upon reasonable request.