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. 2020 Mar 9;6(Suppl 2):S110–S121. doi: 10.1055/s-0039-3402036

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Fig. 12 — Pelosi method. When blood flow cannot be blocked after a major part of the cardinal ligament is cut or when adhesions are extensive in placenta percreta cases, separation of the bladder should be performed in the last step. First, manual separation between the nonadherent vaginal wall under the placenta percreta and the lower part of the bladder should be performed to make a tunnel. The vaginal wall should be held with large curved forceps from the right and left sides, and the blood flow from the vagina should be blocked. Finally, the bladder is separated from the uterus. The area of adhesion. Bladder. (Reproduced with permission from Takeda S, Murayama Y. Cesarean hysterectomy for placenta previa accrete spectrum. In: Hiramatsu Y, Konishi I, Sakuragi N, Takeda S, eds. Mastering the Essential Surgical Procedures OGS NOW, No.9. Surgery for pregnancy with placenta previa and placenta accrete: Careful preparation and critical management. (Japanese). Tokyo: Medical View; 2012:122–133. Copyright © Medical View).