Huseyin Durukan, Kasim Akay
Background and Objectives: This retrospective cohort study aimed to analyze the surgical evolution, clinical outcomes, and adoption of uterus-preserving techniques in placenta previa (PP) and placenta accreta spectrum (PAS) cases managed by a single senior surgeon over an uninterrupted 13-year period. Materials and Methods: A total of 324 patients who underwent cesarean section by a single experienced surgeon with a diagnosis of placenta previa between 1 January 2013 and 1 January 2026 were included in the study. The demographic and obstetric characteristics of the patients, the surgical methods applied, perioperative blood product requirements, complications, and neonatal outcomes were evaluated retrospectively. Uterus-preserving surgical methods included a temporary uterine tourniquet, intrauterine hemostatic sutures, bilateral internal iliac artery ligation (IIAL), Bakri balloon tamponade, B-Lynch suture, uterine lower segment resection, and uterine packing, applied in a stepwise manner. The perioperative hemoglobin change (ΔHb) was calculated as an objective indicator of blood loss. Results: Placenta previa constituted a substantial proportion of all cesarean sections performed by the same surgeon during the study period. Total previa was the predominant type, and almost half of the operations were carried out under emergency conditions. Peripartum hysterectomy was required in a minority of patients, and placenta accreta spectrum was histopathologically confirmed in most of these hysterectomy specimens. The proportion of cases managed with uterus-preserving techniques increased progressively across the series, rising from none in the first year to the great majority of cases in the later years, while the peripartum hysterectomy rate declined correspondingly. On multivariable analysis, a greater number of previous cesarean sections independently increased, and operation during the later years of the series independently reduced the likelihood of peripartum hysterectomy. Perioperative transfusion of at least one blood product was required in more than half of the patients, whereas intensive care admission and perioperative complications were infrequent; bladder perforation was the most common complication. Compared with women whose uterus was preserved, those undergoing hysterectomy were older and had markedly longer operative times, greater blood product consumption, longer hospital stays, and a substantially higher complication rate. No maternal death occurred throughout the 13-year period. Conclusions: In this 13-year single-surgeon experience, the gradual adoption of uterus-preserving techniques was sustainably associated with low maternal morbidity and zero maternal mortality. The markedly higher complication burden observed in the hysterectomy group compared with the uterus-preserving group demonstrates that a standardized step-up surgical approach offers an applicable and effective management strategy even in resource-limited centers.