Total Lower Uterine Segmentectomy With Adjunctive Mechanical Towel Compression for the Surgical Management of Placenta Accreta Spectrum Disorders

Placenta accreta spectrum (PAS) disorders, characterized by abnormal trophoblastic invasion into the myometrium, have seen a global rise in incidence primarily driven by increasing cesarean delivery rates. Massive obstetric hemorrhage remains the leading cause of maternal morbidity and mortality in these cases.

While cesarean hysterectomy is the traditional gold standard for severe PAS, uteruspreserving procedures are increasingly preferred by patients desiring future fertility. Total lower uterine segmentectomy with cervico-corporeal anastomosis (TLS-CCA) is a recognized conservative technique that involves excising the invaded lower segment and reconstructing the uterus. Despite removing the primary placental implantation site, diffuse bleeding from the highly vascularized remaining myometrial bed, dissected bladder flap, and pelvic collateral vessels often persists. While traditional compression sutures or specialized devices are utilized for hemostasis, they can be costly or technically challenging in distorted anatomies. This study introduces a novel, simple, and cost-effective approach: the use of tightly rolled sterile surgical towelsapplied as direct mechanical compression against the lower uterine segment and bladder bed during dissection and reconstruction.

Inclusion criteria

• Maternal age 18-45 years
• Singleton pregnancy
• Antenatal diagnosis of PAS (ultrasound ± MRI)
• Planned elective cesarean delivery
• Candidate for uterine preservation via TLS-CCA
• Provided written informed consent

Exclusion criteria

• Hemodynamic instability necessitating emergency hysterectomy
• Placental invasion into adjacent pelvic organs requiring exenteration
• Pre-existing severe coagulation disorders
• Multiple gestation or major fetal anomalies
• Patient refusal to participate