Placenta accreta spectrum into the parametrium, morbidity differences between upper and lower location

Figures & data

Figure 1. A scheme showing the basic steps for intrasurgical PAS staging. Left: After cutting the peritoneum medially to the round ligament (RL), fingers open the parametrial space between avascular fascia sheets. Right: From the upper position (A), the index goes down (B) by the subperitoneal tissue until crossing the fingers behind the bladder (BL) to perform a Pelosi maneuver. IA: invaded area.

Figure 2. Parasagittal cut on the right female pelvis. An embalmed corpse, the peritoneal sheet of the parametrium was transilluminated. Notice that the parametrium in a straight space has plenty of arteries, veins, and the ureter.

Table 1. Clinical results of patients with upper and lower type 2 PAS placenta invasion.

	Upper type 2 PAS^a (n = 13)	Lower type 2 PAS^b (n = 27)	p value
Bleeding^c	1500 (1400–2000)	2000 (1500–2500)	.0120
Operative time (min)^c	100 (60–130)	120 (60–230)	.3452
Bladder lesion, n (%)	1 (7.7)	7 (25.9)	.0347
Ureteral lesion, n (%)	0	6 (22.2)	.0232
Vascular occlusion requirement, n (%)	3 (23.1)	11 (40.7)	.0010
Pelvic tamponade, n (%)	0	6 (22.2)	.0232
Transfusion, N (%)	10 (76.9)	27 (100)	.0419
RBCs transfused^c	2 (0.5–2.5)	4 (2–4)	.0393
Accreta, n (%)	3 (23.1)	5 (18.5)	.1943
Increta, n (%)	3 (23.1)	3 (11.1)
Percreta, n (%)	7 (53.8)	19 (70.4)
Maternal death, n (%)	0	2 (7.4)
Manual removal of the placenta	7	1
Repeated D&C	4	7
Curettage after cesarean	2	7
Abortion by curettage	0	12	NA

^abc Significance is p < .05.