Placenta Accreta
Conditions
Brief summary
The aim of this study is to evaluate a novel protocol to conserve the uterus during Cesarean delivery indicated for placenta accreta.
Detailed description
Placenta accreta is a morbid obstetric condition that describes variable non-physiologic invasion of the placenta into the the uterine wall. The incidence of placenta accreta, as a serious cause of postpartum hemorrhage, has substantially increased secondary to increase the rate of Cesarean delivery. Placenta accreta is primarily managed by peripartum hysterectomy prior to delivery of the placenta to avoid uncontrolled bleeding. However, in addition to the surgical risks, hysterectomy is psychologically morbid to many women particularly younger women and women with low parity. Therefore, several conservative options were studied to provide an alternative for hysterectomy in these women. Our study is designated to evaluate a proposed protocol of multi-step interventions to reduce the anticipated amount of bleeding prior to delivery of the placenta.
Interventions
PROCEDUREPDI-UC protocol
Preplacental delivery intervention for uterine conservation protocol starts after delivery of the fetus during Cesarean delivery and consists of delayed cord clamping, intramyometrial injection of vasopressin, subdecidual injection of saline, ligation of the uterine arteries, multiple 8 compression sutures, followed by delivery of the placenta, application of pressure and interrupted sutures if needed
Sponsors
Assiut University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Women with placenta accreta at the time of Cesarean delivery
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Women with diagnosis of placenta accreta (US or MRI based diagnosis) * Women who decline hysterectomy * Pregnancy at 28 weeks of gestation or beyond * Women who accept to participate in the study
Exclusion criteria
* Emergency Cesarean delivery (women with active bleeding) * Women with cardiac diseases * Women with coagulopathy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Uterine conservation | Intra-operative (during the time of Cesarean delivery) | Successive Uterine conservation; no peripartum hysterectomy needed |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Severe primary postpartum hemorrhage | From delivery of the fetus to 1 hour after delivery of the fetus | Amount of postpartum bleeding \> 1500 ml |
| Bladder injury | Intra-operative (during the time of Cesarean delivery) | Incidental injury of the bladder during delivery of the placenta or control of bleeding |
| Primary postpartum hemorrhage | From delivery of the fetus to 1 hour after delivery of the fetus | Amount of postpartum bleeding \> 1000 ml |
| Surgical site infection | Up to 2 weeks after Cesarean delivery | Cesarean wound infection |
| Drop in hemoglobin level | Hemoglobin is checked 1 hour prior to Cesarean delivery and again postoperative (24 and 72 hours after Cesarean delivery) | Change in hemoglobin before and more than 24 hours after delivery |
| Bowel injury | Intra-operative (during the time of Cesarean delivery) | Incidental injury of the bladder during delivery of the placenta or control of bleeding |
Contacts
Primary ContactSherif Shazly, MBBCh, MSc
Backup ContactAhmed Abbas, MBBCh, MD
Outcome results
None listed