MANAGING PLACENTA ACCRETA SPECTRUM IN LOW RESOURCE SETTING USING A NOVEL DISSECTION-FREE AORTA CLAMP: OPERATIVE TECHNIQUE

Objective: : Surgical management of Placenta accreta spectrum (PAS) is associated with profuse bleeding and increased risk of operative injury to the adherent pelvic structures. We propose the use of a novel aorta clamp that can occlude the abdominal aorta, without retro-peritoneal dissection, thereby making it easy for the obstetrician to use it. limiting the incident blood loss. Methods: : This is a retrospective chart review of 33 women, with varying grades of histopathology confirmed PAS, who were managed as an elective or emergency procedure in a tertiary center in India. In all cases, the novel Paily Aorta Clamp (PAC) was applied just above the bifurcation of the abdominal aorta. Results: : Twenty-nine women with advanced grades of PAS, underwent sub-total hysterectomies while four women with low grade (focal) PAS underwent a conservative procedure. The procedures were associated with median estimated intra-operative blood loss of 1000 ± 1500 ml with only 51.5% (n = 17) requiring any blood transfusions. PAC was applied for a median 55 ± 20 minutes and was not associated with any peri-operative aortic wall injury or distal thromboembolic phenomenon. Conclusion: : Aortic clamping is feasible without retroperitoneal dissection using the PAC, which can be used to limit operative blood loss and surgical morbidity in PAS disorders.