Comparison between modified one-step surgery vs. Segment Resection vs. placental bed suturing for management of placenta accreta spectrum
Placenta accreta spectrum (PAS) represents a severe obstetric disorder, defined by abnormal migration of the placenta into the myometrium, which leads to incomplete or absent placental separation following delivery. Peripartum caesarean hysterectomy remains the most widely used treatment and is regarded as the gold standard in the majority of clinical settings. Recent international and national guidelines recognize uterus-preserving surgery, including focal resection, as a valid management option in centres of excellence for selected women. However, long-term data on physical outcomes following these procedures remain limited. This study aimed to evaluate intraoperative and postoperative outcomes of patients with placenta accreta spectrum treated with modified one-step conservative surgery, Myometrial segment Resection or placental bed suturing.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
42
transverse uterine incision is made at the upper border of the placenta without cutting through the placenta, then fetal delivery. A tourniquet is first put into the para-cervical area (using a Foley 12-F catheter) to stop active bleeding, and bilateral uterine artery ligation (using Chromic 1/0) is performed, followed by manual placental removal . Myometrial resection is performed if the remaining lower uterine segment of the healthy myometrium measures more than 2 cm. Suture of both edges of the uterine incision and hemostatic sutures of the placental bed surface (using chromic suture 1/0) are performed. Finally, the tourniquet is released and a transverse B-Lynch compression suture is made
transverse uterine incision was applied just above the upper border of involved uterine wall . And the fetus was extracted from this incision and the umbilical cord was clamped. In order to decrease hemorrhage, anterior branches of hypogastric arteries were ligated bilaterally. urinary bladder dissection from anterior uterine wall is done. Then the involved segment is resected by leaving placental free tissue medially to the uterine arteries, below transverse uterine incision and above the cervix. Resection was made by scissors or cautery and bleeding from the borders was controlled by ring forceps.
Women's Health Hospital
Asyut, Egypt
Intraoperative Blood loss
Increased blood loss means bad outcome
Time frame: 24 hours
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After the separation of the placenta, all bleeding areas are clamped with several curved ovarian forceps. After the mechanical hemostasis of the lower uterine segment has been achieved, the remaining small amounts of placental fragments are removed by instrument. The clamps are removed sequentially, and the vesicouterine interface and all spaces are sutured with superficial stitches under the guidance of the surgeon's fingers. These superficial continuous sutures are not very deep. Cho sutures are used to achieve comlete hemostasis.