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.