Transverse uterine fundal incision for placenta praevia with accreta, involving the entire anterior uterine wall: a case series

Objective To determine the feasibility and safety of transverse fundal incision with manual placental removal in women with placenta praevia and possible placenta accreta. Design Case series. Setting Four level-three Japanese obstetric centres. Population Thirty-four women with prior caesarean section and placenta praevia that widely covers the anterior uterine wall, in whom placenta accreta cannot be ruled out. Methods A transverse fundal incision was performed at the time of caesarean section and manual placental removal was attempted under direct observation. Main outcome measure Operative fluid loss. Results The total volume of fluid lost during our operative procedure compares favourably with the volume lost during our routine transverse lower-segment caesarean sections performed in patients without placenta praevia or accreta. The average fluid loss was 1370g. No patients required transfer to intensive care, and there were no cases of fetal anaemia. Conclusions This procedure has the potential to reduce the heavy bleeding that arises from caesarean deliveries in women with placenta praevia and placenta accreta.