Key Takeaways
- One of the highest-volume PAS centers in the world: 619 PAS cases across 132,518 births in just 2 years1
- Developed the MOSCUS technique (Modified One-Step Conservative Uterine Surgery) with 88.9% uterine preservation rate (193/217)
- Published comparative data: 217 MOSCUS cases vs. 79 hysterectomy cases showing lower EBL and fewer visceral injuries with MOSCUS
- Extremely high PAS prevalence: 0.4% of all deliveries at Tu Du due to high cesarean section rates in Vietnam
- Subsequent pregnancy and recurrence data are not yet published
Program Overview
Tu Du Hospital in Ho Chi Minh City is one of the largest maternity hospitals in Southeast Asia and one of the highest-volume PAS centers in the world. The hospital manages an extraordinary volume of deliveries — approximately 66,000 births per year — and encounters PAS at a remarkably high rate due to the elevated cesarean section rate in Vietnam.
Between 2019 and 2021, Tu Du Hospital recorded 619 PAS cases across 132,518 deliveries, representing a PAS prevalence of approximately 0.47% (1 in 214 births) — significantly higher than the global average of approximately 0.17% (1 in 588). This extremely high case volume has allowed the surgical team to develop and refine their own conservative surgical technique.1
The high prevalence of PAS in Vietnam is driven by rising cesarean section rates, which are the single strongest risk factor for PAS in subsequent pregnancies. This epidemiologic pattern mirrors trends seen in other rapidly developing countries with increasing surgical delivery rates.
Fertility Preservation Status
Tu Du Hospital developed and uses the MOSCUS technique (Modified One-Step Conservative Uterine Surgery), achieving an 88.9% uterine preservation rate (193 of 217 patients). This is one of the highest single-technique preservation rates reported in a large PAS series globally.1
Strategy A: MOSCUS (Modified One-Step Conservative Uterine Surgery) — The MOSCUS technique involves excision of the abnormally adherent placenta along with the invaded myometrial tissue, followed by uterine reconstruction. This is performed as a single procedure at the time of cesarean delivery. The technique was developed at Tu Du Hospital to address their extremely high PAS volume.1
Published Outcomes: MOSCUS vs. Hysterectomy (2023)
The comparative study published in 2023 reported outcomes for 296 PAS patients (217 MOSCUS + 79 hysterectomy):1
| Outcome | MOSCUS (n=217) | Hysterectomy (n=79) |
|---|---|---|
| Uterine preservation | 88.9% (193/217) | 0% |
| Median estimated blood loss | 1,000 mL | 1,500 mL |
| Median RBC transfusion | 500 mL | 710 mL |
| Secondary hysterectomy required | 24/217 (11.1%) | — |
| Postoperative infection | Higher (p=0.012) | Lower |
While Tu Du Hospital's preservation rate (88.9%) and case volume are impressive, several important outcomes have not yet been published: subsequent pregnancy rates, term delivery rates, and PAS recurrence rates. These long-term fertility outcomes are critical for patients making decisions about conservative management and are expected to be addressed in future publications.
Key Physicians
Vuong ADB and Team
Department of Obstetrics, Tu Du Hospital, Ho Chi Minh City
The Tu Du Hospital surgical team, led by Vuong and colleagues, developed the MOSCUS technique in response to the hospital's extraordinary PAS volume. The team has refined their approach over hundreds of cases and published their comparative outcomes in 2023. The development of a standardized conservative surgical technique at this volume is a significant contribution to global PAS management.1
Published Outcomes
296-Patient Comparative Study (2023)
The key publication from Tu Du Hospital compared outcomes between 217 MOSCUS patients and 79 hysterectomy patients:1
- 88.9% uterine preservation rate (193/217) with the MOSCUS technique
- Lower estimated blood loss: 1,000 mL (MOSCUS) vs. 1,500 mL (hysterectomy)
- Lower transfusion requirements: 500 mL RBC (MOSCUS) vs. 710 mL (hysterectomy)
- Fewer visceral injuries reported with the MOSCUS approach
- 11.1% secondary hysterectomy rate (24/217) among MOSCUS patients who initially had preservation attempted
- Higher postoperative infection rate in the MOSCUS group (p=0.012) — an important tradeoff consistent with the international literature on conservative management
Institutional Volume
Tu Du Hospital's PAS volume is remarkable by global standards:
Practical Information
Location
- Hospital: Tu Du Hospital (Bệnh viện Từ Dũ), 284 Cong Quynh, District 1, Ho Chi Minh City, Vietnam
- Type: Public tertiary maternity hospital
International Patient Considerations
Tu Du Hospital is one of the largest public maternity hospitals in Vietnam. International patients should consider the following:
- Language: Clinical care is conducted in Vietnamese. International patients should arrange interpreter services in advance.
- Healthcare System: Vietnam has a public healthcare system with very affordable costs by international standards. The hospital also provides services to international patients.
- Travel: Ho Chi Minh City is served by Tan Son Nhat International Airport (SGN) with connections to major international hubs. Flight time from the US West Coast is approximately 16–18 hours (with connections).
- Cost: Medical care in Vietnam is significantly less expensive than in the US or Europe, though international patient services may be priced differently than local services.
- Stay Duration: Patients should plan for several weeks in Ho Chi Minh City, including pre-operative evaluation, surgery, and post-operative recovery.
Clinical Trials
No clinical trials are currently registered at Tu Du Hospital for PAS management. However, the hospital's extraordinary case volume presents significant opportunities for prospective research, and future publications on long-term fertility outcomes are anticipated.
References
- Vuong NL, et al. Modified one-step conservative uterine surgery (MOSCUS) for placenta accreta spectrum: outcomes of 217 cases compared to 79 hysterectomies. 2023. PMID: 38009657