The aim of this study is to evaluate a novel protocol to conserve the uterus during Cesarean delivery indicated for placenta accreta.
Placenta accreta is a morbid obstetric condition that describes variable non-physiologic invasion of the placenta into the the uterine wall. The incidence of placenta accreta, as a serious cause of postpartum hemorrhage, has substantially increased secondary to increase the rate of Cesarean delivery. Placenta accreta is primarily managed by peripartum hysterectomy prior to delivery of the placenta to avoid uncontrolled bleeding. However, in addition to the surgical risks, hysterectomy is psychologically morbid to many women particularly younger women and women with low parity. Therefore, several conservative options were studied to provide an alternative for hysterectomy in these women. Our study is designated to evaluate a proposed protocol of multi-step interventions to reduce the anticipated amount of bleeding prior to delivery of the placenta.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
30
Preplacental delivery intervention for uterine conservation protocol starts after delivery of the fetus during Cesarean delivery and consists of delayed cord clamping, intramyometrial injection of vasopressin, subdecidual injection of saline, ligation of the uterine arteries, multiple 8 compression sutures, followed by delivery of the placenta, application of pressure and interrupted sutures if needed
Uterine conservation
Successive Uterine conservation; no peripartum hysterectomy needed
Time frame: Intra-operative (during the time of Cesarean delivery)
Primary postpartum hemorrhage
Amount of postpartum bleeding \> 1000 ml
Time frame: From delivery of the fetus to 1 hour after delivery of the fetus
Severe primary postpartum hemorrhage
Amount of postpartum bleeding \> 1500 ml
Time frame: From delivery of the fetus to 1 hour after delivery of the fetus
Bladder injury
Incidental injury of the bladder during delivery of the placenta or control of bleeding
Time frame: Intra-operative (during the time of Cesarean delivery)
Bowel injury
Incidental injury of the bladder during delivery of the placenta or control of bleeding
Time frame: Intra-operative (during the time of Cesarean delivery)
Surgical site infection
Cesarean wound infection
Time frame: Up to 2 weeks after Cesarean delivery
Drop in hemoglobin level
Change in hemoglobin before and more than 24 hours after delivery
Time frame: Hemoglobin is checked 1 hour prior to Cesarean delivery and again postoperative (24 and 72 hours after Cesarean delivery)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.