Evaluation of Different Surgical Approaches Used for Conservative Management of Placenta Accreta Spectrum in Sohag University Hospital
Study Details
Study Description
Brief Summary
The objective of this study is to evaluate different intra-operative procedures to control bleeding in cases of PAS disorders aiming to determine the best procedure regarding maternal morbidity and mortality post-operatively, and to evaluate the long-term effects of conservative management of PAS disorders.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
The term "placenta accreta spectrum" (PAS), formerly known as "morbidly adherent placenta" or "abnormally invasive placenta," refers to the aberrant trophoblast invasion of all or a portion of the placenta into the myometrium of the uterus. according to the depth of the villous invasion into the myometrium, the spectrum is assorted into three groups: placenta accreta (villi attach to the myometrium without invading it), placenta increta (villi infiltrate the myometrium), and placenta percreta (villi pierce through the uterine serosa and may infiltrate the surrounding tissues). The optimal strategy for managing PAS disorders remains debatable. Conservative management of PAS disorders includes all techniques aimed at preserving the uterus. Because intraoperative bleeding from PAS disorders is frequently massive and dramatic, causing severe maternal morbidity and mortality, it is essential to have a well-planned, effective, and rapid approach to this surgical challenge.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Group A in which full-thickness vertical compression suture combined with inflated intrauterine balloon are used to control bleeding |
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| Group B in this group, a resective-reconstructive technique is used, which involves resecting the invasive accreta area followed by immediate uterine reconstruction and bladder reinforcement |
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| Group C In this group, bilateral uterine artery ligations combined with cervical tamponade which is performed by elevating the cervix into the uterine cavity with Allis forceps, then suturing the anterior and/ or posterior cervical lip(s) into the anterior and/ or posterior uterine segment(s) depending on the site of bleeding with two or three simple interrupted stitches, with the patency of the cervical canal confirmed, followed by closure of the uterine incision |
Outcome Measures
Primary Outcome Measures
- successful intervention procedure [1 day]
Preservation of the uterus
- maternal mortality and morbidity [6 weeks]
ICU admission, need of re-exploration, drop of hemoglobin and hematocrit values, massive blood transfusion, bladder and/ or ureteric injury, coagulopathy, infection and hospital re-admission within 6 weeks
Eligibility Criteria
Criteria
Inclusion Criteria:
- Women with at least one previous caesarean section and suspected PAS disorders by imaging studies
Exclusion Criteria:
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Patients with intraoperative spontaneous placental separation.
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Patients with a preoperative diagnosis of placenta percreta who chose to have an elective hysterectomy.
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Any other associated uterine pathology requiring hysterectomy.
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Coagulation disorders.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Sohag University | Sohag | Egypt |
Sponsors and Collaborators
- Sohag University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- Soh-Med-22-08-03