Tourniquet, Uterine Inversion, and Placental dissection (TURIP) procedure as a novel hemostatic technique to preserve fertility for placenta accreta spectrum disorders without placenta previa.

The number of cases of placenta accreta spectrum (PAS) disorder has been increasing with the increase in in-vitro fertilization and cesarean sections. In addition, PAS without placenta previa is difficult to diagnose prior to delivery and sometimes requires a hysterectomy due to heavy bleeding. We have devised a uterus-preserving technique (TURIP procedure) for such cases. First, the bleeding is stopped by the Tourniquet method, the uterus is relaxed with nitroglycerin, and the uterus is inverted to expose the adhesion site. After that, the placenta is detached by sharp dissection under direct visualization, and the detached areas are sutured, and then the tourniquet and internal rotation are released. This technique does not require advanced skills. Thus, surgeon could avoid performing a hysterectomy and have a greater chance of uterus preservation when encountering massive hemorrhage due to unpredictable PAS without placenta previa in either cesarean sections or vaginal deliveries.