CONCLUSION
This surgical approach involving delivery of baby through the incised
isthmocele, expeditious uterine exteriorization and systematic manual
removal of the placenta from posterior uterine wall to anterior,
combined with our previously described technique of myometrial defect
repair, can optimally conserve the uterus while reducing the likelihood
of future niche complications in cases of PASD. It is performed within
the uterine boundary which reduces the risk of perioperative
complications. As it is designed for use in high risk situations, where
alternatives are equally fraught with risk, including life threatening
bleeding, training, practice and experience in the technique is
obligatory.