Comparison Between 3 Conservative Surgeries for Placenta Accreta Spectrum
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Modified one-step surgery, Segment Resection, Placental bed suturing.
- Who it may be relevant to
- Registry conditions: Placenta Accreta Spectrum. Basic parameters: No limits · Female.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Egypt
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Modified One Step Surgery vs. Segment Resection vs. Placental Bed Suturing for Management of Placenta Accreta Spectrum
Overview
Comparison between modified one-step surgery vs. Segment Resection vs. placental bed suturing for management of placenta accreta spectrum
Detailed description
Placenta accreta spectrum (PAS) represents a severe obstetric disorder, defined by abnormal migration of the placenta into the myometrium, which leads to incomplete or absent placental separation following delivery. Peripartum caesarean hysterectomy remains the most widely used treatment and is regarded as the gold standard in the majority of clinical settings. Recent international and national guidelines recognize uterus-preserving surgery, including focal resection, as a valid management option in centres of excellence for selected women. However, long-term data on physical outcomes following these procedures remain limited. This study aimed to evaluate intraoperative and postoperative outcomes of patients with placenta accreta spectrum treated with modified one-step conservative surgery, Myometrial segment Resection or placental bed suturing.
Interventions
- Procedure Modified one-step surgery
transverse uterine incision is made at the upper border of the placenta without cutting through the placenta, then fetal delivery. A tourniquet is first put into the para-cervical area (using a Foley 12-F catheter) to stop active bleeding, and bilateral uterine artery ligation (using Chromic 1/0) is performed, followed by manual placental removal . Myometrial resection is performed if the remaining lower uterine segment of the healthy myometrium measures more than 2 cm. Suture of both edges of t - Procedure Segment Resection
transverse uterine incision was applied just above the upper border of involved uterine wall . And the fetus was extracted from this incision and the umbilical cord was clamped. In order to decrease hemorrhage, anterior branches of hypogastric arteries were ligated bilaterally. urinary bladder dissection from anterior uterine wall is done. Then the involved segment is resected by leaving placental free tissue medially to the uterine arteries, below transverse uterine incision and above the cervi - Procedure Placental bed suturing
After the separation of the placenta, all bleeding areas are clamped with several curved ovarian forceps. After the mechanical hemostasis of the lower uterine segment has been achieved, the remaining small amounts of placental fragments are removed by instrument. The clamps are removed sequentially, and the vesicouterine interface and all spaces are sutured with superficial stitches under the guidance of the surgeon's fingers. These superficial continuous sutures are not very deep. Cho sutures a
Primary outcome measures
- Intraoperative Blood loss [Time frame: 24 hours]
Eligibility criteria
Inclusion criteria
- pregnant women with placenta accreta spectrum
Exclusion criteria
- Patients refuse to share in the study
- Pregnant < 28 weeks
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Non-randomized
- Model
- Single group
- Masking
- Double blind
- Primary purpose
- Treatment
Study locations
Egypt · 1 center
- Women's Health Hospital — Asyut
Identifiers
NCT: NCT07520201 · MOSCUS