The Cervix as a Natural Tamponade in Postpartum Hemorrhage Caused by Placenta Previa and Placenta Previa Accreta

Study Overview
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Brief Summary
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Placenta previa and placenta accrete carry significant maternal and fetal morbidity and mortality. Several techniques have been described in the literature for controlling massive bleeding associated with placenta previa cesarean sections. The aim of this study is to evaluate the efficacy and safety of the use of the cervix as a natural tamponade in controlling postpartum hemorrhage caused by placenta previa and placenta previa accreta.

Detailed Description
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Background: Placenta previa and placenta accrete carry significant maternal and fetal morbidity and mortality. The maternal mortality in women with placenta accreta may reach as high as 7-10%. Several techniques have been described in the literature for controlling massive bleeding associated with placenta previa cesarean sections, including uterine packing with gauze, balloon tamponades, the B-Lynch suture, insertion of parallel vertical compression sutures, a square suturing technique and embolization or ligation of the uterine and internal iliac arteries, but there is a wide variation in the success rate of these maneuvers. In a case report, Dawlatly et al. (2007) described a simple technique of suturing an inverted lip of the cervix over the bleeding placental bed that was successful in controlling the bleeding, saving the patient's life, and preserving her uterus. The objective of this trial is to evaluate the safety and efficacy of the use of this Dawlatly stitch as a natural tamponade for controlling postpartum haemorrhage in cases of placenta previa and/ or placenta previa accreta.

Official Title
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The Cervix as a Natural Tamponade in Postpartum Hemorrhage Caused by Placenta Previa and Placenta Previa Accreta: a Prospective Study

Conditions
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Placenta Previa, Placenta Previa Accreta

Intervention / Treatment
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* Procedure: The cervix as a natural tamponade (cervical inversion)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All participating women had one or more previous cesarean deliveries. were diagnosed with placenta previa and/ or placenta previa accreta by ultrasound. When the ultrasound result was not conclusive for placenta accreta, MRI was performed. All participating women desired to preserve their fertility Patients with focal (partial) placenta previa accreta/ placenta previa. Exclusion Criteria: placenta percreta. diffuse placenta accreta or increta. uncontrollable postpartum hemorrhage.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment


Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: The cervix as a natural tamponade (cervical inversion)|Suturing an inverted lip(s) of the cervix over the bleeding placental bed to control the bleeding.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Successful control of postpartum haemorrhage (PPH) | Control of PPH and vaginal bleeding after employing the technique | Intra-operative and up to 24 hours postpartum | 
| Number of cases undergoing hysterectomy to control PPH | Failure of the technique to stop PPH and need for hysterectomy to stop the bleeding | Intra-operative and up to 24 hours postpartum | 
| Incidence of complications |  | short term (intraoperative and up to 6 weeks postpartum)-long term:up to 2 years postpartum |