Conservative Surgery for Placenta Accreta

Ain Shams University62 enrolled

Overview

A stepwise surgical approach for conservative management of placenta previa accreta.

a stepwise surgical approach for conservative management of placenta previa accreta to preserve women's uterus and to evaluate the efficacy and safety of this approach in controlling postpartum hemorrhage including intrapartum hemorrhage associated with conservative management.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Placenta Accreta

Interventions

conservative surgery for uterus in placenta accretaPROCEDURE

After removal of the placenta, grasping the cervix from the both lips and one from each side of the cervical canal at the level of the internal os, each uterine angle and grasped the remaining lower uterine segment and Nelaton catheter was inserted inside the cervical canal to avoid closing the cervix with sutures of the uterine incision.Closing the uterine incision;taking suture at the lateral angle of the cervix and suturing it to the lower edge of the uterine angle, then another continuous suture was attached to the upper edge of the uterine incision angle\[outside in-in out then out in-in out\] and the same technique was repeated on the other side (cervico-isthmic sutures). controlling bleeding from the inner surface of the remaining lower uterine segment was done by 2-3 interrupted sutures between the lower uterine segment and the anterior cervical lip. closing of the uterine incision in continuous non-locking manner

Eligibility

Sex: FEMALEHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Any age. * Any parity. * Previous one or more cesarean delivery. * Placenta previa accreta diagnosis confirmed by gray scale \& color flow Doppler ultrasound in 3rd trimester. All participants had undergone abdominal ultrasound showing placenta previa anterior completely covering the internal os, with criteria suggestive of invasion by U/S Exclusion Criteria: * women with medical disorder * women with bleeding tendency

Locations (1)

Ain SHams Maternity Hospital

Cairo, Abbaseya, Egypt

Outcomes

Primary Outcomes

incidence rate of conserving woman's uterus

success rate of conservative surgery for placenta accreta

Time frame: intraoperative

Secondary Outcomes

number of units of packed red blood cells , Fresh Frozen Plasma transfused ,postoperative haemoglobin

to assess blood loss

Time frame: till 48 hours postpartum

incidence rate of cesarean hysterectomy needed

failure of conservation , increase in blood loss

Time frame: intraoperative and 48 hours postpartum

incidence of puerperal sepsis

temperature chart every 6 hours in 1st 48 hours postpartum then follow up visits 2 weeks and 6 weeks postpartum

Time frame: till 6 weeks postpartum

Data from ClinicalTrials.gov

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