Preoperative assessment and peri-operative prophylactic haemostatic measures.
For antenatally diagnosed cases of PASD the surgery is pre-planned and done by a dedicated team. The patient is counseled on surgical options and associated risks, an anesthetic review is performed and insertion of internal iliac artery (IIA) catheters is offered prophylactically to reduce peri-operative blood loss and blood is available.
Management depends on patient preference towards a conservative approach and needs to be established pre-operatively as the surgery is done under general anesthesia (GA). The method presented here is suitable for women wishing to avoid the prolonged follow up and potential risks associated with IRP but who wish for uterine preservation. Consent needs to include bleeding risk potentially necessitating hysterectomy, possible visceral injury and potential for PASD recurrence or future scar pregnancy if uterine conservation is successful without ligation.