EP16.11: New realm of placenta accreta spectrum: cervical invasion of villous tissue

We aimed to describe a new field of PAS – cervical invasion. It was seldom recognised before but has a major impact on the management. In this retrospective cohort, we enrolled 142 cases of PAS confirming during operation. In these patients, we have disclosed villous invasion by transvaginal sonography as evidenced by the loss of clear zone between cervical region and placenta, abnormal enhancement of placenta tissue nearby, tortuous vessel direct connection between cervix and placenta in 21 cases of them. In these patients with suspected cervical invasion, 12 were not detected before operation and 5 of them received hysterectomy directly. For the other 7 patients, we intended to preserve the uterus initially, but failed to treat conservatively in 4 of them due to uncontrollable bleeding. The remaining 3 patients were either received uterine embolization for hemostasis, or completely asymptomatic with conservative approach. For those patients with antenatal diagnosis of cervical invasion (n = 9), we further divided them into anterior (n = 4) or posterior cervical invasion (n = 5). Posterior cervical invasion can be managed simply using compression suture from posterior cul-de-sac. Management of anterior cervical invasion is more complicated, mainly with the dissection of bladder flap, opening the anterior lower uterine corpus and then directly suturing the anterior cervix. In these patients with antenatal diagnosis, no one need further hysterectomy. Cervical invasion of villous tissue is a new realm of PAS that needs further carefully identification to optimise the outcome of PAS. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.