الفهرس 
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Abstract
Placenta accreta spectrum (PAS) is a challenging obstetric problem with significant morbidity and mortality. Cesarean hysterectomy has been the most commonly used approach to PAS. Conservative management of PAS is increasingly considered for women who are clinically stable and wish to preserve fertility.
In the present study, we compared bilateral uterine artery ligation as an added step (modified technique) to PPC surgical technique (original technique) for conservative management of the uterus in women with PAS. In the first part of the study, We applied this procedure in sixty five cases at women`s Health Hospital, tertiary hospital affiliated to Assiut university between august 2020 and july 2022. We included women who had high possibility of PAS based on preoperative ultrasound and Doppler evaluation, and who had the desire for uterine preservation .
In the second part of study we applied zahran’s technique on sixty five cases at same period.
In the modified PPC technique, bilateral uterine artery ligation done after delivery of the fetus , we waited for spontaneous separation of placenta before starting manual placental separation. We employed placental pouch closure, a modified type of hemostatic sutures in order to control placental site bleeding .
the procedure was feasible and successful in 130 (100%). The mean age of the studied women in years was 30.47 ± 6.29 years in PPC group and 30.97 ± 5.27 in modified group..the great majority of the studied women had previous two or three cesarean sections with mean , 3 (1-6) Vs. 3 (0-7). The mean gestational age at delivery was 35.56 ± 2.33 weeks vs. 34.01 ± 3.03.
In the aspect of surgical complications, bladder injury mean was 18 (27.7%) vs 10 (15.4%). The added step showed significant effect on intraoperative blood loss : P value < 0.001 with mean of 1546.62 ± 212.51ml in PPC group Vs 1149.85 ± 130.54 ml in modified group and the mean blood transfused in units with packed RBCs was 3.23 ± 0.67 Vs 1.77 ± 0.45 and with FFP was 2.50 ± 0.55 Vs 1.50 ± 0.50.
In conclusion, the present study confirm that bilateral uterine artery ligation as an added step for Placental Pouch Closure technique result in dramatic decrease in the amount of intra-operative blood loss and subsequently the need for blood transfusion while still allowing for uterine preservation in women who desire future fertility.
Another beneficial effect of this technique is decrease the hospital stay and bladder injury.