Conservative treatment of adherent placenta in women experiencing uterine bleeding after childbirth

Cervical isthmic opposition suture with bilateral internal iliac artery ligation as a conservative treatment for postpartum hemorrhage in patients with placenta previa accrete

Status

Recruiting

Phases

Unknown

Study type

Interventional

Source

ANZCTR

Registry ID

ACTRN12616000793415

Enrollment

Registered

2016-06-17

Start date

2015-04-08

Completion date

2016-07-15

Last updated

2020-01-13

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

OBJECTIVE: To report our experience with a new conservative management approach to treat postpartum hemorrhage (PPH) due to placenta previa accreta. We evaluated the control of postpartum hemorrhage by isthmic-cervical apposition suture and iliac artery ligation. METHODS: A prospective interventional study that will include 20 patients with placenta previa accreta who undergo a conservative management protocol . Inclusion: not desiring future fertility, placenta previa centralis and accrete .Exclusion : unstable , poor availability of blood . The protocol consists of transverse compression suture of lower uterine segment with bilateral iliac artery ligation . Isthmic-cervical apposition suture was applied . A No.1 vicryl on curved needle was passed through the uterus from cevix down up to the uterine incision including the lower uterine segment . This will be followed or preceded with bilateral internal iliac artery ligation .

Interventions

The protocol consists of transverse compression suture of lower uterine segment with bilateral iliac artery ligation . Isthmic-cervical apposition suture will be applied . A qualified obstetrician with minimum 5 years of surgical experience will perform this procedure, A No.1 vicryl on curved needle will be passed through the uterus from cevix down up to the uterine incision including the lower uterine segment . The needle will be passed from the anterior to the posterior aspect of the uterus and then brought back from the posterior through the anterior wall and tied anteriorly. This will be applied on the oozing side of the lower uterine segment avoiding the cervical canal keeping a tract for a continuous flow. This will be followed with bilateral internal iliac artery ligation .

Study design

Allocation

Non-randomised trial

Intervention model

Single group

Primary purpose

Treatment

Masking

Open (masking not used)

Eligibility

Sex/Gender

All

Age

18 Years to 45 Years

Healthy volunteers

Inclusion criteria

women not desiring future fertility, placenta previa centralis and accrete on ultrasound women who experience postpartum hemorrhage on removal of the placenta with placental invasion suspicious of placenta accreta

Exclusion criteria

hemodynamically unstable patients , poor availability of blood products for transfusion

Outcome results