LAUSR

Recently, an alternative strategy for uterine conservation with completely leaving the placenta in situ was extensively discussed and recommended [7]. To some extent, we agree with Prof. Shigeki Matsubara in regarding this “hand-off” approach might be a current acceptable approach for abnormally invasive placentas. However, we had to emphasize the complications after leaving placentas in situ, especially the ratios of requiring additional vessel embolism or ligation procedures (65%), postpartum hemorrhage (51%) [8] and further surgery (60%) with emergent hysterectomy (40%) [9], which restricted its application only to centers equipped [8]. Thereby, for medical institutes without adequate equipment and sufficient resources, probably not the minority, the conventional management according to our classification (Fig. 1) is still in use to preserve uterus. As a medical center of south China, although being equipped with more technologies or resources for complicated medical conditions, we are also responsible for developing feasible and effective clinical practices for different levels of medical institutes within our network. As designed (Fig. 1), a variety of managements including the conventional management, leaving the placenta in situ as well as the newly reported 3-P procedures had been enrolled in our network. Just as mentioned in Introduction section of our article, the motivation to drive our simplification from the devascularization to be a Foley catheter was to improve the feasibility for lower level medical institutes without interventional radiology suite. Therefore, both groups in our study were designed as inability to provide devascularization, and patients admitted to our medical network in early 2014 with unexpected placenta removal surgeries were enrolled retrospectively. Undoubtedly, Teixidor et al.’s study was meaningful for high level medical institutes to determine an optimal strategy from their abundant choices. Similarly, we just expected to add evidences for our modified “3-P Dear Editor,