{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T04:29:58Z","timestamp":1786681798739,"version":"build-2736575974"},"reference-count":36,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This retrospective cohort study aimed to analyze the surgical evolution, clinical outcomes, and adoption of uterus-preserving techniques in placenta previa (PP) and placenta accreta spectrum (PAS) cases managed by a single senior surgeon over an uninterrupted 13-year period. Materials and Methods: A total of 324 patients who underwent cesarean section by a single experienced surgeon with a diagnosis of placenta previa between 1 January 2013 and 1 January 2026 were included in the study. The demographic and obstetric characteristics of the patients, the surgical methods applied, perioperative blood product requirements, complications, and neonatal outcomes were evaluated retrospectively. Uterus-preserving surgical methods included a temporary uterine tourniquet, intrauterine hemostatic sutures, bilateral internal iliac artery ligation (IIAL), Bakri balloon tamponade, B-Lynch suture, uterine lower segment resection, and uterine packing, applied in a stepwise manner. The perioperative hemoglobin change (\u0394Hb) was calculated as an objective indicator of blood loss. Results: Placenta previa constituted a substantial proportion of all cesarean sections performed by the same surgeon during the study period. Total previa was the predominant type, and almost half of the operations were carried out under emergency conditions. Peripartum hysterectomy was required in a minority of patients, and placenta accreta spectrum was histopathologically confirmed in most of these hysterectomy specimens. The proportion of cases managed with uterus-preserving techniques increased progressively across the series, rising from none in the first year to the great majority of cases in the later years, while the peripartum hysterectomy rate declined correspondingly. On multivariable analysis, a greater number of previous cesarean sections independently increased, and operation during the later years of the series independently reduced the likelihood of peripartum hysterectomy. Perioperative transfusion of at least one blood product was required in more than half of the patients, whereas intensive care admission and perioperative complications were infrequent; bladder perforation was the most common complication. Compared with women whose uterus was preserved, those undergoing hysterectomy were older and had markedly longer operative times, greater blood product consumption, longer hospital stays, and a substantially higher complication rate. No maternal death occurred throughout the 13-year period. Conclusions: In this 13-year single-surgeon experience, the gradual adoption of uterus-preserving techniques was sustainably associated with low maternal morbidity and zero maternal mortality. The markedly higher complication burden observed in the hysterectomy group compared with the uterus-preserving group demonstrates that a standardized step-up surgical approach offers an applicable and effective management strategy even in resource-limited centers.<\/jats:p>","DOI":"10.3390\/medicina62081552","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T14:45:06Z","timestamp":1786545906000},"page":"1552","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Uterus-Preserving Surgery for Placenta Previa and Placenta Accreta Spectrum: Retrospective Analysis of the Evolution of a Standardized Step-Up Approach in a 13-Year Single-Surgeon Cohort of 324 Cases"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5894-3421","authenticated-orcid":false,"given":"Huseyin","family":"Durukan","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Mersin University, 33110 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6098-2259","authenticated-orcid":false,"given":"Kasim","family":"Akay","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Osmaniye D\u00fczi\u00e7i State Hospital, 80600 Osmaniye, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref_1","first-page":"e1","article-title":"Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a","volume":"126","author":"Jauniaux","year":"2019","journal-title":"BJOG"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1097\/AOG.0000000000001005","article-title":"Abnormal Placentation: Placenta Previa, Vasa Previa, and Placenta Accreta","volume":"126","author":"Silver","year":"2015","journal-title":"Obstet. Gynecol."},{"key":"ref_3","first-page":"e-rbgo1","article-title":"Prevalence and Risk Factors for Placenta Previa in a Specialty Hospital","volume":"47","year":"2025","journal-title":"Rev. Bras. Ginecol. Obstet."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1097\/01.AOG.0000219750.79480.84","article-title":"Maternal Morbidity Associated with Multiple Repeat Cesarean Deliveries","volume":"107","author":"Silver","year":"2006","journal-title":"Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1097\/AOG.0000000000000245","article-title":"Fetal Imaging: Executive Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop","volume":"123","author":"Reddy","year":"2014","journal-title":"Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"266","DOI":"10.20344\/amp.14001","article-title":"Placenta Accreta Overlying a Caesarean Section Scar: A 10-Year Experience in a Tertiary-Care Centre in Portugal","volume":"34","author":"Cal","year":"2021","journal-title":"Acta Med. Port."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.bpobgyn.2020.07.009","article-title":"Conservative Surgical Approach: The Triple P Procedure","volume":"72","author":"Chandraharan","year":"2021","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e44906","DOI":"10.1097\/MD.0000000000044906","article-title":"Risk Factors and Maternal-Neonatal Outcomes of Placenta Accreta Spectrum: A Case Control Study","volume":"104","author":"Tang","year":"2025","journal-title":"Medicine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.placenta.2020.01.004","article-title":"Trophoblast Invasion: Lessons from Abnormally Invasive Placenta (Placenta Accreta)","volume":"102","author":"Illsley","year":"2020","journal-title":"Placenta"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9910316","DOI":"10.1155\/2024\/9910316","article-title":"A Novel Approach for Conservative Management of Placenta Accreta Spectrum Disorder Cases: Experience of a Single Surgeon","volume":"2024","year":"2024","journal-title":"J. Pregnancy"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Pan, S., Han, M., Zhai, T., Han, Y., Lu, Y., Huang, S., Zuo, Q., Jiang, Z., and Ge, Z. (2024). Maternal Outcomes of Conservative Management and Cesarean Hysterectomy for Placenta Accreta Spectrum Disorders: A Systematic Review and Meta-Analysis. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06658-x"},{"key":"ref_12","first-page":"175","article-title":"Evaluation of Peripartum Hysterectomy: Ten Years of Experience of a Tertiary Center","volume":"26","author":"Dirik","year":"2021","journal-title":"East. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.ajog.2023.10.047","article-title":"Delivery Outcomes in the Subsequent Pregnancy Following the Conservative Management of Placenta Accreta Spectrum Disorder: A Systematic Review and Meta-Analysis","volume":"230","author":"Javinani","year":"2024","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1002\/ijgo.12407","article-title":"FIGO Consensus Guidelines on Placenta Accreta Spectrum Disorders: Epidemiology","volume":"140","author":"Jauniaux","year":"2018","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.ajog.2019.01.233","article-title":"Prevalence and Main Outcomes of Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis","volume":"221","author":"Jauniaux","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/aogs.14096","article-title":"A Multicenter Observational Survey of Management Strategies in 442 Pregnancies with Suspected Placenta Accreta Spectrum","volume":"100","author":"Stefanovic","year":"2021","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101365","DOI":"10.1016\/j.ajogmf.2024.101365","article-title":"Moving the Needle Forward in Evidence-Based Care for Placenta Accreta Spectrum","volume":"6","author":"Fox","year":"2024","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1080\/01443615.2019.1634019","article-title":"Retrospective Analysis of 586 Cases of Placenta Previa and Accreta","volume":"40","author":"Peng","year":"2020","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Cetinkaya Demir, B., Ozerkan, K., Kosan, B., Aslan, M.K., and Uncu, G. (2026). Management and Outcomes of 308 Placenta Accreta Spectrum Cases at a Multidisciplinary Tertiary Center in Turkey: A 16-Year Experience. BMC Pregnancy Childbirth, 26.","DOI":"10.1186\/s12884-026-08820-z"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kirovakov, Z., Yordanov, A., and Tsoneva, E. (2026). Placenta Accreta Spectrum: Diagnostic Challenges and Management Strategies. Diagnostics, 16.","DOI":"10.3390\/diagnostics16050760"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/aogs.14120","article-title":"Maternal and Neonatal Outcomes in Planned versus Emergency Cesarean Delivery for Placenta Accreta Spectrum: A Multinational Database Study","volume":"100","author":"Morlando","year":"2021","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"100718","DOI":"10.1016\/j.ajogmf.2022.100718","article-title":"Timing of Delivery for Placenta Accreta Spectrum: The Pan-American Society for the Placenta Accreta Spectrum Experience","volume":"4","author":"Salmanian","year":"2022","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"79","DOI":"10.4274\/tjod.galenos.2021.72437","article-title":"A Novel Low Uterine Segment Sandwich Technique (Caliskan\u2019s Technique) for the Management of Post-Cesarean Hemorrhage due to Placenta Previa Accreta","volume":"18","author":"Akar","year":"2021","journal-title":"Turk. J. Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S226","DOI":"10.1016\/j.ajog.2025.04.018","article-title":"Surgical Management of Complex Cesarean Delivery","volume":"233","author":"Fox","year":"2026","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_25","first-page":"e47648","article-title":"Blood Transfusion Predictors in Cesarean Sections for Pregnancies with Placenta Accreta and Placenta Previa: A Monocentric Tertiary Experience","volume":"15","author":"Alhashim","year":"2023","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.ejogrb.2019.04.026","article-title":"Coagulopathy in Surgical Management of Placenta Accreta Spectrum","volume":"237","author":"Shamshirsaz","year":"2019","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"409","DOI":"10.17085\/apm.20076","article-title":"Management of Massive Hemorrhage in Pregnant Women with Placenta Previa","volume":"15","author":"Park","year":"2020","journal-title":"Anesth. Pain Med."},{"key":"ref_28","first-page":"e64071","article-title":"Managing Placenta Accreta and Massive Hemorrhage: A Case Report on Anesthetic and Surgical Interventions","volume":"16","author":"Laranjo","year":"2024","journal-title":"Cureus"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"337.e1","DOI":"10.1016\/j.ajog.2019.05.035","article-title":"Maternal Outcomes in Unexpected Placenta Accreta Spectrum Disorders: Single-Center Experience with a Multidisciplinary Team","volume":"221","author":"Erfani","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e486","DOI":"10.1055\/a-1905-5079","article-title":"Patient Perception of Care, Outcomes, and Consequences from Placenta Accreta Spectrum: A Survey-Based Study","volume":"41","author":"Shainker","year":"2024","journal-title":"Am. J. Perinatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.ajog.2015.04.034","article-title":"Conservative Management of Morbidly Adherent Placenta: Expert Review","volume":"213","author":"Fox","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"291","DOI":"10.3109\/14767058.2013.818118","article-title":"Planned Conservative Management of Placenta Accreta: Experience of a Regional General Hospital","volume":"27","author":"Lo","year":"2014","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Abousifein, M., Shishkina, A., and Leyland, N. (2024). Addressing Diagnosis, Management, and Complication Challenges in Placenta Accreta Spectrum Disorder: A Descriptive Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13113155"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1080\/14767058.2020.1716715","article-title":"Placenta Accreta Spectrum: A Hysterectomy Can Be Prevented in Almost 80% of Cases Using a Resective-Reconstructive Technique","volume":"35","author":"Fiorillo","year":"2022","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/aogs.14103","article-title":"Association of Peripartum Management and High Maternal Blood Loss at Cesarean Delivery for Placenta Accreta Spectrum (PAS): A Multinational Database Study","volume":"100","author":"Schwickert","year":"2021","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/aogs.14085","article-title":"Developing a Database for Multicenter Evaluation of Placenta Accreta Spectrum","volume":"100","author":"Braun","year":"2021","journal-title":"Acta Obstet. Gynecol. Scand."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1552\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T04:13:18Z","timestamp":1786680798000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1552"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":36,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["medicina62081552"],"URL":"https:\/\/doi.org\/10.3390\/medicina62081552","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]}}}