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OBJECTIVES: To describe a stepwise, systematic technique for radical caesarean hysterectomy for placenta accreta spectrum (PAS). To investigate outcomes for women with severe, invasive PAS, who were hysterectomised using this technique. STUDY DESIGN: A retrospective cohort study, undertaken at a large UK tertiary referral centre. Twenty-four cases of elective primary caesarean hysterectomy with a confirmed intrapartum diagnosis of severe percreta (FIGO grades 3b and c) were identified between 2011 and 2020. Sixteen had standard care (surgical technique dependant on surgeon's preference) and eight had the radical peri-partum hysterectomy using the SAC-technique as described. Non-parametric testing was used due to sample size. RESULTS: The SAC-technique resulted in significantly less blood loss (P=0.032), more transverse incisions (p=0.009) and less ICU admissions (p=0.046). There was no significant difference in theatre time. CONCLUSION: (s) The SAC-technique demonstrated a significant improvement in outcomes for women with severe PAS, without increasing surgical time.

Original publication




Journal article


Am J Obstet Gynecol

Publication Date



Caesarean hysterectomy, Placenta accreta spectrum, Severe percreta, surgery