Conservative surgical approach: The Triple P procedure

Abstract

The incidence of abnormally invasive placenta (AIP) or currently called placenta accreta spectrum (PAS) disorders has increased worldwide over the last few decades. Although the exact physiopathology is not yet well established, there is consensus that an increase in the Caesarean section rates, uterine surgery and the advanced maternal age are important contributory factors. Traditionally, the treatment for PAS has been a peripartum hysterectomy. Conservative measures have been reported in the literature include an intentional retention of the placenta (IRP) or partial myometrial excision. We present an alternative conservative approach, the Triple P procedure. It involves three main steps: perioperative localization of the upper placental edge, pelvic devascularization and the placental non-separation with myometrial excision followed by the repair of the myometrial defect. The aim of this approach is to reduce the intra- and post-operative complications associated with a peripartum hysterectomy, to reduce the time of surgery and to minimize common complications of placental retention, such as infection, sepsis secondary postpartum haemorrhage and coagulopathy.

Keywords: Abnormal invasion of placenta; Major obstetric haemorrhage; Peripartum hysterectomy; Placenta accreta; Postpartum haemorrhage.