PAGE 16

15. conflict of interest. The authors have no conflict of interest.

15. contradiction. There is no contradiction.

7. this procedure is a surgical althernative to perpartum hysterectomy or

conservative management of morbidly adherent placenta.
7. this procedure is a surgical preference or conservative management of
morbidly adherent placenta could be the surgical preference of the peripartum
hysterectomy

7. in addition, it also avoids the potential intraoperative and postoperative

complications associated with hysterectomy during childbirth
7. the other benefit of this procedure is can be minimalize the other
probability risk intraoperative and postoperative complications related
hysterectomy during childbirth

7. this procedure as an alternative to peripartum hysterectomy or conservative

management of adherent placenta.
7. this method as other preference instead of hysterectomy during childbirth.

PAGE 1
6. the diagnose of placenta accreta is when placental vili attack surface layer
of the myometrium, in other words the placenta does not detached from
myometrium completely or partially.

6. Placenta accreta was an infrequent event in a tertiary center, as on

reported there is rising number of incidence from1 of 2510 (in 1994) TO 1 in
533 deliveries (in 2002) in consequence of increasing rate of cesarean
sections.

PAGE 2
7. these previous uterine trauma caused by cesarean section, myomectomy,
traumatic uterine curettage and intrauterine sepsis are usually damage
desidua basalis so it affect placental adherence out of the normal path.

12. the risk of placenta accreta increase progressively in correlation with the
number of repeated cesarean deliveries. Oher significant independent risk
factors include co existent placenta previa and maternal age.
12. The high number of cesarean deliveries is related to escalation risk of the
placenta accreta. There are also maternal age and previous placenta previa
have contribute to placenta accreta

13. among women with placenta previa, the incidence of placenta accreta is
nearly 10%,
13. women with plasenta previa have assist about 10% incidence risk of
placenta accreta

1. sign of placenta ccreta could be seen since the first semester with the
ultrasonographic. The sonographic picture shows inadequate uterine
implantation, vascular multiplication placenta, more hypoechoic
retroplacental zone and deviation/aberration of the uterine serosa-bladder
interface. However, for diagnose placenta accreta is more sensitivity and
specificity by ultrasound. However, rare cases that can not be diagnosed by
ultrasound can use MRI

14 & 11

PAGE 3
4. ideally, the diagnosis might be evaluated antenatally in high risk
pregnancies and suspected using ultrasound. This could allow for predelivery
planning to reduce maternal morbidity and mortality. Unfortunately, most
cases are identified only at the time of delivery when forcible attempts at
manual removal of the placenta are unsuccessful. Severe postpartum
hemorrhage may result and may lead to comlications such as massive
transfusion of blood products; DIC; acute renal failure; infectious morbidities;
ARDS; loss of fertality.
4. suspicion of placenta accreta can be evaluated during antenatal high-risk
pregnancy using ultrasound which is expected to reduce mortality and
morbidity. however, in most cases, placenta accreta can only be known at the
time of the delivery of the placenta manually by force and can cause serious
postpartum haemorrhage that lead to complications such as massive blood
products transfussion; DIC; acute renal failure; infectious morbidities; ARDS;
loss of fertility.

2. This time, the main goal of this treatment is to maintain uterine function as
best as possible, to prevent the possibility of bleeding and subsequent
pregnancy

PAGE 5
3. in this study, we report a comprehensive surgical procedures and the
results of 26 cases of placenta accreta which we have operated with
conservative management

9. the study was carried out from January 2008 to july 2016 in various tertiary
care center for high-risk obstetrics hospitals, Jakarta, Indonesia. The entire
surgical procedures were undertaken by the author (ADP) who Is Consultant
were experienced with Gynecologic cancer surgery

page 6
3. this prospective method, surgical case series study include 27 sequent
placenta accrete patients who were diagnosed at the tertiary care center
hospital (Jakarta, Indonesia) from 2008 to 2016 since pre natal.
7. informed consent was given, as each hospital care plan.