Comparison Between Bladder Dissection Before and After Uterine Incision in Cesarean Section for Morbidly Adherent Placenta

Study Overview
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Brief Summary
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Comparison between bladder dissection at the beginning of cesarean section For morbidly adherent placenta and between delaying dissection until planning for cesarean hysterectomy

Official Title
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Comparison Between Bladder Dissection Before and After Uterine Incision in Cesarean Section for Morbidly Adherent Placenta

Conditions
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Morbidly Adherent Placenta

Intervention / Treatment
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* Procedure: bladder dissection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women with BMI at or under 35 Kg/m2. Women having previous two cesarean section or more. Women with gestational age more than 32 weeks with viable fetus. Women with any degree of placenta previa . Patient with morbidly adherent placenta on cesarean scar only. Exclusion Criteria: Patient who are haemodynamically unstable before skin incision. Patient with clinically evident intraamniotic infection. Patient with previous history of bladder injury .

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: bladder dissection before uterine incision<br> | Procedure: bladder dissection<br>* Comparison between bladder dissection at the beginning of cesarean section For morbidly adherent placenta and between delaying dissection until planning for cesarean hysterectomy<br>|
| Experimental: bladder dissection after uterine incision<br> | Procedure: bladder dissection<br>* Comparison between bladder dissection at the beginning of cesarean section For morbidly adherent placenta and between delaying dissection until planning for cesarean hysterectomy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Operative time | of whole cs | icluding all cs over the period of one year | 
| Blood loss | through counting soaked towels and weighting them before and after being soaked considering the difference in grams as the calculated blood loss and calculating blood in the suction reservoir and comparing pre and post operative Hb level also haemotacrit level and number of units of packed RBCs transfused | icluding all cs over the period of one year | 
| - Incidence of urological | - Incidence of urological injuries discovered intraoperative and procedure needed to repair or as a late complication as fistula formation. | during cs and post operative delayed complication icluding all cs over the period of one year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neonatal APGAR score | Neonatal APGAR score | after delivery of the baby during the 1st 15 minutes | 
| Time taken to create bladder flap | from the start of bladder dissection | from the start of bladder dissection icluding all cs over the period of one year | 
| 3 months post operative filling cystometry | 3 months post operative filling cystometry | 3 months post operative |