Method for preventing massive bleeding and preserving the uterus in case of abnormal placentation, and evaluation of its effectiveness

BACKGROUND: In recent decades, the incidence of placenta previa has increased worldwide, driven by rising rates of abdominal delivery, the risk of abnormal placental attachment, and a growing proportion of women with uterine scars. The primary treatment for central placenta previa, with or without placenta accreta, was hysterectomy. However, various methods of bleeding prevention, including endovascular and organ-preserving techniques, are now being employed. АIM: The aim of this study was to evaluate the effectiveness of the developed method of single-stage organ-preserving surgery for pathological placentation. METHODS: This cross-sectional prospective study involving 58 pregnant women with abnormal placental attachment was conducted from May 2023 to January 2026. The main group consisted of 38 pregnant women with central placenta previa who underwent organ-preserving surgery during cesarean section using a method we developed (Patent FAP 2847 dated October 23, 2025). The comparison group comprised 20 women with the same condition who underwent hysterectomy during cesarean section without an attempt to preserve the uterus. The data obtained were analyzed using variation statistics; changes were considered significant at a level of p 0.05. After fetal extraction, without separating the placenta, two pairs of vessels on both sides were ligated with Vicryl suture: the main trunk of the uterine artery up to its bifurcation (0.5–1 cm outward from the bifurcation, thereby blocking blood flow through the cervical branches and devascularizing the placental bed, which is the primary source of blood loss during placental separation) and the round ligaments. RESULTS: Intraoperative blood loss in the main group averaged 765.8 ± 50 ml, which was lower than in the comparison group (1,545 ± 150 ml), p 0.05. No blood transfusions were required in the main group. The duration of surgery was reduced to an average of 50 minutes, with the hospital stay shortened by 3 days. In all cases in the main group, the uterus was preserved, and menstrual and reproductive functions were not impaired. CONCLUSION: The proposed organ-preserving method for preventing bleeding in abnormal placentation allows for a 50% reduction in intraoperative blood loss and surgical duration, avoiding blood transfusions and radical interventions, and preserving the uterus in 100% of cases.

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