CLAP – a new organ-preserving surgery for combined placenta praevia accreta vera into the uterine cicatrix after the previous cesarean section

Abstract

Objective: to describe a new method of organ-preserving surgery for combined placenta previa and placenta accreta into the uterine scar after a previous cesarean section – the CLAP method. Materials and methods. During 2015–2020, 29 women with placenta praevia and placenta accreta vera into the uterine scar after a previous cesarean section were operated. 15 women (control group) gave birth using the traditional method – cesarean section followed by hysterectomy; in 14 pregnant women (main group) the new method CLAP was used. CLAP consists of the following stages: stage I – C – cesarean section; stage II – L – ligation of internal iliac arteries; stage III – A – adherent placenta's area excision; stage IV – P – pressure, applied to the lower uterine segment, during which the technique of COLUS was performed. Patients were operated at 34–35 weeks of pregnancy after fetal respiratory distress syndrome prophylactics with a course of betamethasone.Results. Statistically significant difference in the age of patients (p = 0.968), status and weight of newborns (p = 0.058) was not found. But significant statistical difference was found in the amount of maternal blood loss during surgical delivery. In the control group, where pregnant women underwent hysterectomy, it was 3652 ± 293 ml, and in the main group, where delivery was performed using the new CLAP technique, blood loss was 2253 ± 153 ml (p <0.001). All patients were discharged in satisfactory condition on the 8th–10th day. Conclusions. CLAP procedure is an effective alternative to previously used organ-preserving operations. It helps to avoid hysterectomy and does not require special equipment during a cesarean section. The CLAP technique has proven to be an effective way to prevent and cease blood loss, as well as to preserve reproductive function of woman.