Author's reply re: Caesarean hysterectomy for placenta praevia/accreta using an approach via the pouch of Douglas

occlusion of the iliac internal artery does not have a firm recommendation to reduce blood loss, so it is not clear why he used it. Additionally, he interrupted the blood supply in the cervicovaginal junction, a fact that demonstrates the poor efficacy of major arterial ligature in abnormal invasive placentation. After appraise a video (supporting by the author), we cannot realise the advantages of this technique to solve the dissection of the vesicouterine plane because we cannot find any evidence of anterior abnormal placentation, such as bulging, myometrial thinning or newly formed vessels between the bladder, the uterus and the placenta. Unfortunately, there is no viewing of the invaded area before or after the surgery; for this reason, it is not possible to conclude if this case is a true placenta accreta or percreta. The author should be able to demonstrate that in his experience this technique reduces maternal morbidity (bleeding and bladder lesions), compared with traditional hysterectomy or previously published conservative techniques. We hope that obstetricians think deeply about this technique before using it, mainly to understand that is not an easy solution for abnormal placentation cases, and also that Dr Matsuzaki be recognised as the original author of this approach.&