Early vs Late Bladder Dissection During CS Hysterectomy in Patients With PAS With Bladder Invasion

Study Overview
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Brief Summary
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Thirty-six singleton pregnant women with PAS and bladder invasion; total anterior or anterolateral invasion, who were scheduled for cesarean hysterectomy were randomly assigned into two equal groups Group 1: included 18 pregnant women scheduled for classical cesarean hysterectomy for placenta accreta with or without ligation of anterior division of internal iliac artery before cesarean section. Group 2: included 18 pregnant women scheduled for bladder last cesarean hysterectomy with or without ligation of anterior division of internal iliac artery.

Official Title
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Early vs Late Bladder Dissection During Cesarean Hysterectomy in Patients With Placenta Accreta Spectrum With Bladder Invasion

Conditions
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Placenta Accreta Spectrum, Cesarean Hysterectomy

Intervention / Treatment
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* Procedure: Late bladder dissection
* Procedure: early bladder dissection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age: reproductive age. Pregnant with singleton living fetus. Previous one or more cesarean sections. Gestational age: > 34 weeks. Elective or non-emergency cesarean sections. Preoperative hemoglobin more than 9.5 gm/dl. Exclusion Criteria: Women with history of any medical disorder with pregnancy eg. gestational diabetes, hypertension, or anemia.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 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 |
| --- | --- |
| Placebo Comparator: Group 1<br>18 pregnant women scheduled for classical cesarean hysterectomy for placenta accreta | Procedure: early bladder dissection<br>* The bladder dissection is early as in classic cesarean hysterectomy<br>|
| Experimental: Group 2<br>18 pregnant women scheduled for bladder last cesarean hysterectomy | Procedure: Late bladder dissection<br>* The bladder dissection is reserved as the last step of the cesarean hysterectomy with excellent dissection of the ureteric course till the ureteric tunnel to reduce the incidence of inadvertent ureteric clamping during uterine vessel ligating and transection<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Amount of blood loss |  | during cesarean hysterectomy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Operative time |  | during cesarean hysterectomy | 
| bladder injury |  | during cesarean hysterectomy | 
| ureteric injury |  | during cesarean hysterectomy | 
| Need for massive blood transfusion |  | during cesarean hysterectomy |