the Treatment of Postpartum Hemorrhage Due to Placenta Previa Complete Centralis
Condition: Placenta Previa Complete Centralis
MeSH terms: Postpartum Hemorrhage; Placenta Previa; Hemorrhage
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      Objective: To assess the efficacy of lower uterine compression sutures (involved bilateral
      uterine artery ligation and compression of the lower uterine segment at the same time with
      one circular stitch) as a conservative treatment for the treatment of postpartum hemorrhage
      in women with placenta previa complete centralis. Method: This prospective study of 50 women
      with postpartum hemorrhage following removal of placenta previa complete centralis during
      elective cesarean section. All 50 patients will have lower uterine compression sutures
      (involving bilateral uterine artery ligation and compression of the lower uterine segment at
      the same time with one circular stitch). All patients will be followed postpartum for
      evaluation of uterine cavity and menstrual cycles
    

Detailed description: 
      The investigators conduct a prospective study at Department of Obstetrics and Gynecology,
      Benha University Hospital, since June 2012 till July 2014, after approval of the study
      protocol by the Local Ethical Committee.

      All patients provide written informed consent to undergo any procedure necessary, including
      lower uterine compression suturing procedure, as an attempt to avoid hysterectomy. They also
      provide written informed consent to undergo hysterectomy if all measures attempted to
      preserve the uterus fail.

      All patients have placenta previa (50). The inclusion criteria are a gestation age of ≥ 28
      weeks and antepartum hemorrhage; intraoperative postpartum hemorrhage and discovery of a
      placenta accreta; and an adherent placental part after piecemeal removal of the placenta,
      with bleeding from the placental site, posterior placenta previa and/or successful piecemeal
      removal of the placenta.

      The first author performed all cesarean deliveries and assisted by the second author. We open
      the parietal peritoneum by sharp dissection and blunt expansion, high above the bladder, a
      bladder flap is made and the bladder is retracted. A small median transverse hysterotomy
      incision is done in the lower uterine segment. It is expanded on both sides using scissors,
      stopping shortly before the uterine arteries. Active delivery of the placenta is attempted by
      searching manually for a plane of cleavage between the placenta and the uterus after delivery
      of the fetus. The study technique comprise lower uterine compression sutures (involved
      bilateral uterine artery ligation and compression of the lower uterine segment at the same
      time with one circular stitch).
    

Intervention name(s): lower uterine compression sutures
Intervention type(s): Procedure
Intervention description(s): intervention is lower uterine compression sutures (involved bilateral uterine artery ligation and compression of the lower uterine segment at the same time with one circular stitch) as a conservative treatment for the treatment of postpartum hemorrhage in women with placenta previa complete centralis.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Postpartum Hemorrhage; Placenta Previa; uterine cavity