Placenta implantation, especially large penetrating placenta implantation, can easily lead to uncontrollable hemorrhage during cesarean section, which greatly increases the rate of hysterectomy and even endangers life. In view of the fact that some patients with placental implantation are diagnosed only when the placenta is not successfully delivered during labor or cesarean section, forcible detachment of the placenta may easily lead to uncontrollable hemorrhage, especially in primary hospitals due to the limitations of medical technology and conditions, which still poses a serious threat to patients’ life safety. Therefore, it is the goal of obstetricians to make the most accurate diagnosis possible, make adequate preoperative preparations, choose the most appropriate treatment plan, and minimize the trauma to the mother. At present, the preoperative diagnosis of placenta praevia combined with placental implantation mainly relies on color Doppler ultrasound and MRI. The literature reports that the sensitivity of transabdominal color Doppler ultrasound for prenatal diagnosis of placenta praevia combined with placental implantation is 77.3% and the specificity is 98.4%. For high-risk patients with placenta praevia, color Doppler ultrasonography should be preferred. For those who cannot make a clear conclusion by color Doppler ultrasonography, especially if the placenta is located in the posterior wall of the uterus, MRI examination should be used to improve the diagnostic accuracy. Some scholars also advocate the use of MRI combined with ultrasound Doppler to diagnose placenta praevia combined with placental implantation. In our hospital, most of these patients are referred from other hospitals, and many of them have already been initially diagnosed with placenta implantation in other hospitals. After the patients come to our hospital, our experienced obstetric ultrasonographer will perform ultrasound examination, and then MRI examination will be performed for those who suggest that the placenta is implanted in a large area through the uterine wall, and the obstetrician will make a comprehensive diagnosis by combining all clinical data. In recent years, there have been several cases in which the placenta implantation was not diagnosed in the local hospital before surgery, but after the abdominal cavity was opened during surgery, a large placenta implantation was found, and due to the lack of relevant surgical experience and medical conditions, the patient was transferred to our hospital for emergency cesarean delivery after closing the abdomen. In these cases, the mother and child had good outcomes. Thus, we summarize and analyze as follows: preoperative diagnosis of fatal placenta praevia should be emphasized, and the presence of placental implantation, depth and area of implantation should be understood. If the placenta implantation is not detected preoperatively but diagnosed intraoperatively, it is an effective remedy for the primary hospital to terminate the operation and transfer to a hospital with treatment capability after closing the abdomen. The application of abdominal aortic balloon block in cesarean section for placental implantation must have strict indications and must not be abused. Properly applied, it has the following advantages: (1) reduction of intraoperative massive bleeding and related complications due to massive blood transfusion; (2) reduction of the risk of hysterectomy; (3) reduction of medical costs: although the use of this technique increases certain cost (about 5,000-6,000 RMB for disposable catheter plus surgery), it significantly reduces the amount of transfused red blood cells and other blood products, eliminates the need for additional uterine artery embolization, and eliminates the need for admission to the ICU ward after surgery. Like any other technique, each technique has its own advantages and disadvantages. If the indications for the use of this technique are not strictly grasped, the cases are not selected properly, and the operation specifications are not strictly observed, it will only increase the complications and unnecessary costs and will not reflect its advantages. In our hospital, this technique has been used since May 2013 in cesarean section for aggressive placenta praevia with large penetrating placenta implantation, and more than 300 cases have benefited so far. Henan Province is the largest province in China, and our hospital is a large comprehensive hospital, gathering a large number of difficult and serious patients in the province and even in the neighboring provinces. Since we started this technique, we have indeed obtained very good results in treating these patients, and it has been recognized by our colleagues and patients in the province, so more of these patients are referred to our hospital. The indications for choosing this technique are: most of our patients are referred from other hospitals, and many of them have been initially diagnosed with placental implantation in other hospitals. The procedure should be performed only in cases of large penetrating placenta implantation. It should be emphasized that the use of abdominal aortic balloon block during cesarean section is only one of the measures to reduce intraoperative bleeding. The choice of uterine incision, intraoperative suturing techniques to stop bleeding and the ability to prevent various possible complications are still key to the final prognosis of the patient. Hysteroplasty is performed for large penetrating placental implantation in the anterior wall of the uterus, which can significantly reduce intraoperative bleeding and operating time and effectively preserve the uterus. Surgical method: A small incision of about 25px in length is made above the lower part of the anterior uterine wall where there is no placenta attached or the placenta is thin, and the amniotic sac is quickly exposed and clamped. After aspiration of amniotic fluid, the uterine incision is bluntly lengthened and the fetus is rapidly delivered. The fetus is delivered while the abdominal aortic balloon is filled to block the abdominal aortic flow. The uterine bladder is bluntly separated from the retroflexed peritoneum and the bladder is pushed down to remove part of the anterior uterine wall (thin, plasma layer of the uterus only) along with the placenta. The lower edge of the hysterotomy is lifted (because part of the anterior uterine wall is removed, the lower edge of the hysterotomy is close to the cervical os) and sutured to the upper edge of the hysterotomy (part of the upper edge of the hysterotomy on both sides is misplaced as part of the lower edge of the hysterotomy) to restore the integrity of the uterus, i.e., hysteroplasty. Features and advantages of choosing the location of the uterine incision: The lower part of the anterior wall of the uterus is chosen to make the incision without placenta attachment or a thin placenta, so as to avoid blood loss to the pregnant woman and the fetus in the uterus caused by large blood sinus or large blood vessel rupture due to the conventional taking of the lower uterine incision. Features and advantages of hysteroplasty: This procedure avoids bleeding and subsequent hemostasis of a large number of broken vessels on the detached surface after direct detachment of the placenta, which is equivalent to reducing the area requiring hemostasis (because the uterine wall removed together with the placenta is extremely thin or only the plasma layer of the uterus, even if the placenta is detached first, it will eventually be trimmed and removed), thus reducing the time and amount of bleeding requiring hemostasis. As part of the lower anterior uterine wall is removed, the operative field becomes shallower and easier to expose and hemostatic manipulation. For patients with placenta praevia combined with large penetrating placental implantation, our hospital has adopted the above-mentioned comprehensive treatment model, and most patients can be treated without blood transfusion. For some patients with more bleeding who still need blood transfusion, our hospital has carried out the intraoperative autologous blood recovery technique for cesarean delivery, which greatly saves blood sources and reduces the transfusion of allogeneic blood, thus significantly reducing the complications and risks of allogeneic complications and risks of allogeneic blood transfusion. V. Regarding partial or total placenta preservation in situ Clausen et al. systematically reviewed 52 data involving 119 patients with placental implantation, of which 36 patients with placenta preservation in situ had more complications of bleeding and infection, and 58% (21/36) required delayed hysterectomy; a multicenter retrospective study in France reported that 167 patients with placental implantation underwent placenta preservation in situ. In a multicenter retrospective study in France, placenta preservation in situ was performed in 167 patients with placental implantation, 59% with partial placenta preservation, 41% with total placenta preservation, 78.4% with successful uterine preservation, and 6% with death. In view of the high risk of rebleeding, infection and other serious complications, I personally do not recommend partial or total in situ placenta preservation for those who deliver by cesarean section, and all placentas are removed during cesarean section in these patients in our hospital, and the uterus is successfully preserved, basically achieving zero hysterectomy rate and zero placenta residual rate, all with good prognosis; while for those who deliver vaginally without prenatal diagnosis For patients with vaginal delivery without prenatal diagnosis, if there is not much bleeding and the vital signs are stable, under the premise of full communication, it is also recommended to implement placenta preservation in situ and take comprehensive treatment such as medication, interventional embolization, uterine curettage and hysteroscopic electrosurgery. Sixth, the importance of preserving the uterus The uterus is one of the important organs of women, which is not only responsible for reproductive functions, but also has certain endocrine functions itself; in addition, hysterectomy has a certain impact on some couples psychologically, although the literature reports inconsistent views on the impact of hysterectomy on the quality of sexual life, some couples still think that the loss of the female symbolic organ affects the couple’s feelings. Of course, for all patients, individualized treatment plans should be taken into account. For example, in primary care hospitals, if a severe placental implantation is not diagnosed preoperatively and the surgeon does not have the surgical ability to preserve the uterus, decisive hysterectomy is an important life-saving measure; after all, life is above all.