In the management of morbidly adherent placenta (MAP — accreta spectrum), which surgical approach is associated with the lowest maternal blood loss and best outcomes according to current evidence?

• A Classical caesarean section with attempted manual placental removal
• B Caesarean hysterectomy leaving the placenta in situ without attempted removal ✓
• C Uterine artery embolisation followed by spontaneous placental resorption
• D Conservative management with delayed interval hysterectomy after 6 weeks

Explanation

In cases of confirmed placenta accreta spectrum (especially increta/percreta), planned caesarean hysterectomy with the placenta left in situ (no attempt at placental removal) at a tertiary centre with multidisciplinary team is associated with the lowest intraoperative blood loss and morbidity. Attempts to manually remove an adherent placenta cause catastrophic haemorrhage. Uterine artery embolisation with delayed hysterectomy is an option in select cases but carries higher risks. The key principle is avoiding forceful placental separation.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.