Selective Placenta feeding vessels Embolization, Resection and Reconstruction of the lower uterine segment: A Technique for Uterine Preservation in PAS.

Placenta accreta spectrum (PAS) is associated with significant maternal morbidity. Over time, the incidence of PAS has risen in parallel with increasing cesarean delivery rates. Planned cesarean hysterectomy has historically been considered the gold standard treatment; however, this approach carries substantial surgical morbidity and eliminates future fertility. As a result, increasing attention has been directed toward conservative, uterine-sparing strategies. These approaches broadly include leaving the placenta in situ or performing surgical resection and reconstruction of the affected lower uterine segment. Following the formalization of a complex obstetrical surgery team, we established a technique and protocol for conservative management for PAS. In this manuscript we describe a protocolized conservative surgical technique termed SPERR: Selective Placenta feeding vessels Embolization, Resection, and Reconstruction of the lower uterine segment. The procedure details how, following selective embolization of placenta-feeding vessels (originating from the internal iliac and uterine vessels), the adhered placenta and affected anterior uterine wall are resected and reconstructed resulting in surgical excision of the accreta. To date, our institution has performed ten SPERR procedures without requiring hysterectomy. This technique demonstrates the potential to reduce hemorrhage, and can minimize injury to surrounding pelvic structures. Protocolized conservative surgical management may represent a viable alternative to planned cesarean hysterectomy in carefully selected PAS cases.