Placenta Previa, Placenta Previa Accreta
Conditions
Brief summary
Placenta previa and placenta accrete carry significant maternal and fetal morbidity and mortality. Several techniques have been described in the literature for controlling massive bleeding associated with placenta previa cesarean sections. The aim of this study is to evaluate the efficacy and safety of the use of the cervix as a natural tamponade in controlling postpartum hemorrhage caused by placenta previa and placenta previa accreta.
Detailed description
Background: Placenta previa and placenta accrete carry significant maternal and fetal morbidity and mortality. The maternal mortality in women with placenta accreta may reach as high as 7-10%. Several techniques have been described in the literature for controlling massive bleeding associated with placenta previa cesarean sections, including uterine packing with gauze, balloon tamponades, the B-Lynch suture, insertion of parallel vertical compression sutures, a square suturing technique and embolization or ligation of the uterine and internal iliac arteries, but there is a wide variation in the success rate of these maneuvers. In a case report, Dawlatly et al. (2007) described a simple technique of suturing an inverted lip of the cervix over the bleeding placental bed that was successful in controlling the bleeding, saving the patient's life, and preserving her uterus. The objective of this trial is to evaluate the safety and efficacy of the use of this Dawlatly stitch as a natural tamponade for controlling postpartum haemorrhage in cases of placenta previa and/ or placenta previa accreta.
Interventions
PROCEDUREThe cervix as a natural tamponade (cervical inversion)
Suturing an inverted lip(s) of the cervix over the bleeding placental bed to control the bleeding.
Sponsors
Minia University
Study design
Primary purpose
TREATMENT
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Inclusion criteria
1. All participating women had one or more previous cesarean deliveries. 2. were diagnosed with placenta previa and/ or placenta previa accreta by ultrasound. When the ultrasound result was not conclusive for placenta accreta, MRI was performed. 3. All participating women desired to preserve their fertility 4. Patients with focal (partial) placenta previa accreta/ placenta previa.
Exclusion criteria
1. placenta percreta. 2. diffuse placenta accreta or increta. 3. uncontrollable postpartum hemorrhage.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Successful control of postpartum haemorrhage (PPH) | Intra-operative and up to 24 hours postpartum | Control of PPH and vaginal bleeding after employing the technique |
| Number of cases undergoing hysterectomy to control PPH | Intra-operative and up to 24 hours postpartum | Failure of the technique to stop PPH and need for hysterectomy to stop the bleeding |
| Incidence of complications | short term (intraoperative and up to 6 weeks postpartum)-long term:up to 2 years postpartum | — |
Countries
Egypt
Contacts
Primary ContactAhmed R Abdelraheim, MD, MRCOG
Outcome results
None listed