Total Lower Uterine Segmentectomy With Adjunctive Mechanical Towel Compression for the Surgical Management of Placenta Accreta Spectrum Disorders
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
- This is an observational study: the protocol does not assign a study treatment.
- Who it may be relevant to
- Registry conditions: Placenta Accreta Management. Basic parameters: 18 years — 45 years · 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
- Center list to be confirmed — check the primary protocol.
- 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
Total Lower Uterine Segmentectomy With Adjunctive Mechanical Towel Compression for the Surgical Management of Placenta Accreta Spectrum Disorders: A Case Series
Overview
The goal of this observational study is to evaluate the feasibility and safety of utilizing adjunctive mechanical towel compression during TLS-CCA, measured primarily by estimated intraoperative blood loss in patient with Maternal age 18-45 years - Singleton pregnancy - Antenatal diagnosis of PAS (ultrasound ± MRI) - Planned elective cesarean delivery - Candidate for uterine preservation via TLS-CCA - Provided written informed consent
Detailed description
Placenta accreta spectrum (PAS) disorders, characterized by abnormal trophoblastic invasion into the myometrium, have seen a global rise in incidence primarily driven by increasing cesarean delivery rates. Massive obstetric hemorrhage remains the leading cause of maternal morbidity and mortality in these cases.
While cesarean hysterectomy is the traditional gold standard for severe PAS, uteruspreserving procedures are increasingly preferred by patients desiring future fertility. Total lower uterine segmentectomy with cervico-corporeal anastomosis (TLS-CCA) is a recognized conservative technique that involves excising the invaded lower segment and reconstructing the uterus. Despite removing the primary placental implantation site, diffuse bleeding from the highly vascularized remaining myometrial bed, dissected bladder flap, and pelvic collateral vessels often persists. While traditional compression sutures or specialized devices are utilized for hemostasis, they can be costly or technically challenging in distorted anatomies. This study introduces a novel, simple, and cost-effective approach: the use of tightly rolled sterile surgical towelsapplied as direct mechanical compression against the lower uterine segment and bladder bed during dissection and reconstruction.
Primary outcome measures
- Estimated intraoperative blood loss [Time frame: at operation]
Secondary outcome measures (1)
- Blood transfusion requirements [Time frame: intraoperative]
Eligibility criteria
Inclusion criteria
- Maternal age 18-45 years
- Singleton pregnancy
- Antenatal diagnosis of PAS (ultrasound ± MRI)
- Planned elective cesarean delivery
- Candidate for uterine preservation via TLS-CCA
- Provided written informed consent
Exclusion criteria
- Hemodynamic instability necessitating emergency hysterectomy
- Placental invasion into adjacent pelvic organs requiring exenteration
- Pre-existing severe coagulation disorders
- Multiple gestation or major fetal anomalies
- Patient refusal to participate
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Study design
- Observational model
- Other
Study locations
Center list to be confirmed — check the primary protocol.
Identifiers
NCT: NCT07706062 · Nourhan