A patient with placenta previa accreta spectrum (PAS) undergoes cesarean delivery. Intraoperatively, the placenta does not separate spontaneously. The most appropriate surgical management to reduce maternal morbidity in a facility experienced with PAS surgery is:

• A Manual removal of placenta followed by curettage and haemostatic sutures
• B Hysterectomy without attempting placental removal, leaving placenta in situ ✓
• C Uterine artery ligation followed by attempted placental peel
• D Prophylactic balloon occlusion of internal iliac arteries followed by manual removal

Explanation

For placenta accreta spectrum (PAS), the definitive and safest surgical management in experienced centres is peripartum hysterectomy without prior attempted placental removal, because attempts to manually separate the placenta cause life-threatening haemorrhage. The 'leaving placenta in situ' approach is reserved for centres without sufficient surgical expertise or in fertility-preserving management. Manual removal (Option A) precipitates catastrophic haemorrhage. Prophylactic iliac balloon occlusion has not consistently reduced hysterectomy rates in RCTs.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.