الفهرس 
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Abstract
Summary
The incidence of placenta accreta has been increasing alarmingly in the developed as well as the developing world; (Khong 2008).It has increased 10 folds in the last 50 years primarily because of the rise in cesarean sections rates (Chou et al 2003). The indications for cesarean delivery is steadily expanding, the incidence of placenta accreta is likely to continue to increase (Warshak et al 2010).
It is becoming a more common complication of pregnancy. Prenatal diagnosis is important in optimizing the counseling, treatment, and outcome of women with placenta accreta. Surgical treatment for placenta accreta is commonly performed as hysterectomy. However, conservative management should be the preferred approach especially for pregnant women who want to retain their future fertility.
Variable modalities for conservative management were prescribed and all providers try to choose in between these modalities to reduce perinatal morbidity and mortality
In this study, we have presented a comprehensive approach to conservative treatment for placenta accreta cases.
We enrolled 22 pregnant women attending Beni suef university hospital and Beni Suef public hospital for caesarian delivery due to abnormal placental site and invasion.
The study was declared for Ethical and Research approval and the nature of the study was explained for each patient before enrollment in the study and verbal consent for inclusion in it was obtained.
They were more than 32 weeks of pregnancy with Placenta previa and have evidence of accreta (grey scale U/S, 3 D U/S, Doppler or MRI).Their hemoglobin level was over 9 mg/dl. Well preparation preoperatively for fitness of surgery and for the availability of blood for transfusion.
Elective surgery was done at around 36 weeks of pregnancy. In this work we aimed to evaluate variable maneuvers in conservative surgical management of placenta accreta.
We worked on prenatally diagnosed cases of placenta accreta, planned for conservative surgery at elective time, incised the uterus away of the placental site, Infusion of hot saline combined with oxytocine into the umbilical vein, Hypo perfusion of uterus by ligation of both the utero ovarian anastomosis and hypo gastric arteries, hydro dissection of placenta, leaving intrauterine balloon as a pack and haemostatic sutures were done.
We evaluate cases for the need for hysterectomy, number of required blood transfusion products, hospitalization time, need for ICU admission, serum BHCG at 6 weeks postnatally and Intraoperative and postoperative complications
No marked postoperative hemorrhage or major complications were noticed.