Placenta Accreta Spectrum
Conditions
Brief summary
participants diagnosed as placenta accreta spectrum were subjected to cesarean delivery. Investigators manually detected a plan of cleavage through which the placenta was separated followed by closure of defective placental bed. Data were collected about the outcome.
Detailed description
Demographic data, detailed history taking, routine blood tests were done. Trans-abdominal and trans-vaginal ultrasound to diagnose placenta accreta spectrum ( PAS). Detecting new signs to help sure diagnosis of PAS. Cesarean section will be performed through extended transverse supra-pubic incision bladder dissection from anterior uterine wall using electro-coagulation instruments and double ligation of large caliber bridging vessels. Uterine incision above the placental bulge by at least 5 mm then complete separation of the placenta starting from least resistance plans to high resistant one leaving a clear defect which will be closed by running sutures from inside the uterus and controlling placental bed hemorrhage then closing the uterine incision with compressing the bed from outwards ( double compression sutures ) internal Iliac artery ligation may be done as a complementary measure to control the bleeding from abnormal pelvic vasculature, insertion of intraperitoneal drain and closure of abdominal wall in layers.
Interventions
DIAGNOSTIC_TESTultrasound
trans-vaginal and trans-abdominal ultrasound using different modalities such as grey-scale, Doppler, multi-planer mode
PROCEDUREclosure of uterine wall defect
uterine incision above placental bulge by at least 5 mm then complete separation of the placenta starting from areas of least resistance to areas of high resistance leaving a clear defect which will be closed by non locked running sutures from inside the uterus starting from one edge, hitch the bed to the other edge of the defect and controlling placental bed hemorrhage then closing the uterine incision via running sutures in 2 layers with compressing the bed from outwards in the first layer. hemostasis of the abnormal pelvic vasculature if excessive bleeding internal iliac artery may be ligated then insertion of intra-peritoneal drain followed by closing the abdomen.
Sponsors
Alexandria University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Investigators conducting prospective study for management of placenta accreta spectrum including diagnosis and uterine sparing surgery.
Eligibility
Sex/Gender
FEMALE
Age
19 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* pregnant women diagnosed as placenta accreta spectrum with previous Cesarean section, with or without other uterine surgeries and less than 40 years of age.
Exclusion criteria
* pregnant women having medical conditions such as cardiac diseases, coagulopathy and hematological disorders. pregnant women had 5 or more previous Cesarean sections or their age more than 40 years
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| total operation time | intra-operative | the time taken from the start of the skin incision to the skin closure |
| manual cervical assesment | before skin incision | participants were subjected to vaginal examination to asses the cervix lenght |
| placental separation | intra-operative | number of participants whom their placenta was separated manually |
| surgical grading of the placenta | intra-operative | number of participants who had accreta, increta, percreta or mixed type |
| ultrasound grading of the placenta | pre-operative | number of participants who were diagnosed by ultrasound as accreta, increta or percreta |
| manual assessment of vaginal fornices | before skin incision | participants were subjected to vaginal examination to assess fornices |
| repair time | intra-operative | the time recorded from the end of the placental separation to the closure of the first layer of the uterus |
| surgical outcome | from the time of the surgery until 48 hours after. | number of participants whom their uterus were preserved without major hemorrhage |
| intra-operative blood loss | intraoperative | the amount of blood loss during operation was estimated for each participant. |
| surgical complications | intraoperative | number of participants had bladder, ureter injury or hysterectomy, |
| internal iliac artery ligation | intra-operative | number of participants had with either unilateral or bilateral internal iliac artery ligation |
| high dependency unit admission | from 0 to 48 hours postoperative | number of participants needed high dependency unit admission |
| wound complications | up to 2 weeks postoperative | number of patients suffered wound infection |
| change in the hemoglobin level | from 48 hours pre operative to 48 hours post operative | participant's hemoglobin was measured |
| blood transfusion | from 48 hours preoperative to 48 hours postoperative. | number of units of blood and it's products transfused to participants |
| hematuria | post-operative up to 24 hours | number of participants suffered hematuria |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| placental bed | intra-operative | number of participants that investigators detected a well delineated placental bed like a pouch |
| pouch site | intra-operative | the site of the pouch in relation to the cervix |
| defect site | intra-operative | the location of the myometrium defects |
Other
| Measure | Time frame | Description |
|---|---|---|
| significance of the pouch | peri-operative | the investigators determine the relation of the pouch to estimated blood loss |
| Pathology | From the operation time for 48 hours | Histopathological examination of 1 cm specimen from the myometriam attached to the placenta in random cases |
| new ultrasound sign the pouch | pre-operative | number of participants that the investigators detected the previously noticed pouch by ultrasound. |
Countries
Egypt
Outcome results
None listed