Conservative Surgery for Placenta Accreta

Study Overview
=================
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.

Official Title
-----------------
Long-term Follow-up of the Cases Who Underwent Conservative Surgery for Placenta Previa Accreta

Conditions
-----------------
Placenta Accreta

Intervention / Treatment
-----------------
* Procedure: conservative surgery for uterus in placenta accreta


Participation Criteria
=================
Eligibility Criteria
-----------------
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
Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Any age and parity with placenta accreta spectrum<br>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 | Procedure: conservative surgery for uterus in placenta accreta<br>* 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<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| incidence rate of conserving woman's uterus | success rate of conservative surgery for placenta accreta | intraoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of units of packed red blood cells , Fresh Frozen Plasma transfused ,postoperative haemoglobin | to assess blood loss | till 48 hours postpartum | 
| incidence rate of cesarean hysterectomy needed | failure of conservation , increase in blood loss | intraoperative and 48 hours postpartum | 
| incidence of puerperal sepsis | temperature chart every 6 hours in 1st 48 hours postpartum then follow up visits 2 weeks and 6 weeks postpartum | till 6 weeks postpartum |