Placenta Accreta
Conditions
Brief summary
A stepwise surgical approach for conservative management of placenta previa accreta.
Detailed description
a stepwise surgical approach for conservative management of placenta previa accreta to preserve women's uterus and to evaluate the efficacy and safety of this approach in controlling postpartum hemorrhage including intrapartum hemorrhage associated with conservative management.
Interventions
PROCEDUREconservative surgery for uterus in placenta accreta
After removal of the placenta, grasping the cervix from the both lips and one from each side of the cervical canal at the level of the internal os, each uterine angle and grasped the remaining lower uterine segment and Nelaton catheter was inserted inside the cervical canal to avoid closing the cervix with sutures of the uterine incision.Closing the uterine incision;taking suture at the lateral angle of the cervix and suturing it to the lower edge of the uterine angle, then another continuous suture was attached to the upper edge of the uterine incision angle\[outside in-in out then out in-in out\] and the same technique was repeated on the other side (cervico-isthmic sutures). controlling bleeding from the inner surface of the remaining lower uterine segment was done by 2-3 interrupted sutures between the lower uterine segment and the anterior cervical lip. closing of the uterine incision in continuous non-locking manner
Sponsors
Ain Shams University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
Yes
Inclusion criteria
* Any age. * Any parity. * Previous one or more cesarean delivery. * Placenta previa accreta diagnosis confirmed by gray scale & color flow Doppler ultrasound in 3rd trimester. All participants had undergone abdominal ultrasound showing placenta previa anterior completely covering the internal os, with criteria suggestive of invasion by U/S
Exclusion criteria
* women with medical disorder * women with bleeding tendency
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| incidence rate of conserving woman's uterus | intraoperative | success rate of conservative surgery for placenta accreta |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| number of units of packed red blood cells , Fresh Frozen Plasma transfused ,postoperative haemoglobin | till 48 hours postpartum | to assess blood loss |
| incidence rate of cesarean hysterectomy needed | intraoperative and 48 hours postpartum | failure of conservation , increase in blood loss |
| incidence of puerperal sepsis | till 6 weeks postpartum | temperature chart every 6 hours in 1st 48 hours postpartum then follow up visits 2 weeks and 6 weeks postpartum |
Countries
Egypt
Outcome results
None listed