participants diagnosed as placenta accreta spectrum were subjected to cesarean delivery. Investigators manually detected a plan of cleavage through which the placenta was separated followed by closure of defective placental bed. Data were collected about the outcome.
Demographic data, detailed history taking, routine blood tests were done. Trans-abdominal and trans-vaginal ultrasound to diagnose placenta accreta spectrum ( PAS). Detecting new signs to help sure diagnosis of PAS. Cesarean section will be performed through extended transverse supra-pubic incision bladder dissection from anterior uterine wall using electro-coagulation instruments and double ligation of large caliber bridging vessels. Uterine incision above the placental bulge by at least 5 mm then complete separation of the placenta starting from least resistance plans to high resistant one leaving a clear defect which will be closed by running sutures from inside the uterus and controlling placental bed hemorrhage then closing the uterine incision with compressing the bed from outwards ( double compression sutures ) internal Iliac artery ligation may be done as a complementary measure to control the bleeding from abnormal pelvic vasculature, insertion of intraperitoneal drain and closure of abdominal wall in layers.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
159
trans-vaginal and trans-abdominal ultrasound using different modalities such as grey-scale, Doppler, multi-planer mode
uterine incision above placental bulge by at least 5 mm then complete separation of the placenta starting from areas of least resistance to areas of high resistance leaving a clear defect which will be closed by non locked running sutures from inside the uterus starting from one edge, hitch the bed to the other edge of the defect and controlling placental bed hemorrhage then closing the uterine incision via running sutures in 2 layers with compressing the bed from outwards in the first layer. hemostasis of the abnormal pelvic vasculature if excessive bleeding internal iliac artery may be ligated then insertion of intra-peritoneal drain followed by closing the abdomen.
Faculty of Medicine
Alexandria, Egypt
surgical outcome
number of participants whom their uterus were preserved without major hemorrhage
Time frame: from the time of the surgery until 48 hours after.
intra-operative blood loss
the amount of blood loss during operation was estimated for each participant.
Time frame: intraoperative
surgical complications
number of participants had bladder, ureter injury or hysterectomy,
Time frame: intraoperative
internal iliac artery ligation
number of participants had with either unilateral or bilateral internal iliac artery ligation
Time frame: intra-operative
high dependency unit admission
number of participants needed high dependency unit admission
Time frame: from 0 to 48 hours postoperative
wound complications
number of patients suffered wound infection
Time frame: up to 2 weeks postoperative
change in the hemoglobin level
participant's hemoglobin was measured
Time frame: from 48 hours pre operative to 48 hours post operative
blood transfusion
number of units of blood and it's products transfused to participants
Time frame: from 48 hours preoperative to 48 hours postoperative.
hematuria
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number of participants suffered hematuria
Time frame: post-operative up to 24 hours
manual cervical assesment
participants were subjected to vaginal examination to asses the cervix lenght
Time frame: before skin incision
placental separation
number of participants whom their placenta was separated manually
Time frame: intra-operative
surgical grading of the placenta
number of participants who had accreta, increta, percreta or mixed type
Time frame: intra-operative
ultrasound grading of the placenta
number of participants who were diagnosed by ultrasound as accreta, increta or percreta
Time frame: pre-operative
manual assessment of vaginal fornices
participants were subjected to vaginal examination to assess fornices
Time frame: before skin incision
repair time
the time recorded from the end of the placental separation to the closure of the first layer of the uterus
Time frame: intra-operative
total operation time
the time taken from the start of the skin incision to the skin closure
Time frame: intra-operative
placental bed
number of participants that investigators detected a well delineated placental bed like a pouch
Time frame: intra-operative
pouch site
the site of the pouch in relation to the cervix
Time frame: intra-operative
defect site
the location of the myometrium defects
Time frame: intra-operative