José Miguel Palacios-Jaraquemada Livres

Abnormal placental adhesive disorders lead to significant hemorrhage and increased maternal morbidity and mortality, with repeated cesarean sections being the primary risk factor. Specific diagnostic techniques are essential, requiring precise skills to identify signs, avoid common mistakes, and understand their appropriate application. Presurgical studies are crucial for assessing diagnosis, extent, and involvement of adjacent structures like the bladder or parametrium. Knowledge of placental invasion is vital for planning surgeries such as hysterectomy or conservative approaches. Mapping the invasion is necessary to determine effective proximal vascular control, as the topography of the invaded area correlates with specific arterial pedicles. In situations lacking resources or skilled teams, leaving the placenta in situ may be preferable, though it demands intensive postoperative monitoring for complications like infection or bleeding. While hysterectomy may seem straightforward for inexperienced operators, it often presents significant challenges, with potential morbidity and mortality linked to hemodynamic and hemostatic issues. This work compiles the latest findings on etiology, diagnosis, and treatment, along with the author's extensive experience from over 500 cases, covering all aspects of management, including vascular control, urology, anesthesia, and hemodynamic considerations.