Placenta Accreta Spectrum Management: Uterine Preservation Using JSICA Technique - Retrospective Cross-Sectional Study

Study Overview
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Brief Summary
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The goal of this study is to present the Jakarta Surgical Uterine Conservation (JSICA) technique and its perioperative outcomes in Placenta Accreta Spectrum patients. Participants are all patients undergoing standard hysterectomy or the Jakarta Surgical Uterine Conservation (JSICA) technique. Researchers will compare both groups to see if there are any differences in the perioperative outcomes.

Detailed Description
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This study uses data from Cipto Mangunkusumo General Hospital's Placenta Accreta Case Register. This register includes all patients with a confirmed placenta accreta spectrum diagnosis. Data collected includes demographic characteristics, risk factors, surgery characteristics, and perioperative outcomes. In this study, researchers would like to evaluate the perioperative outcomes of the JSICA technique in comparison to a standard hysterectomy.

Official Title
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Placenta Accreta Spectrum Management: Uterine Preservation Using JSICA Technique - Retrospective Cross-Sectional Study

Conditions
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Placenta Accreta

Intervention / Treatment
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* Procedure: Jakarta Surgical Uterine Conservation (JSICA) Technique
* Procedure: Standard Hysterectomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for JSICA: Focal accreta invasion ( < 50% anterior wall) Anterior invasion No parametrial or bladder invasion Residual tissue or healthy myometrium min 3 cm above the OUI or cervix Good uterine contraction post-repair (with or without compression sutures) Hemodynamically stable Exclusion Criteria: -

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Jakarta Surgical Uterine Conservation (JSICA) technique<br>Cipto Mangunkusumo General Hospital's novel uterine preservation technique based on standard procedure | Procedure: Jakarta Surgical Uterine Conservation (JSICA) Technique<br>* a. Identifying the placenta accrete site; b. Meticulous dissection to create a bladder flap; c. Incision 1 cm above the placenta accrete; d. Fetal delivery; e. Bottom incision to resect the placenta; f. Placental delivery; g. Uterus without placenta; h. The resection area is approximated using interrupted horizontal mattress suture; i. The continuous suture used to close all incision areas; j. Evaluation of uterine contraction<br>|
| Active Comparator: Standard Hysterectomy<br>Surgery to remove the uterus | Procedure: Standard Hysterectomy<br>* The main types of hysterectomy are abdominal, vaginal, and laparoscopic hysterectomy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intraoperative bleeding | Intraoperative bleeding in this study was measured by the amount of blood loss (cc) and classified into < 1.000 cc, 1.000-1.500 cc, and > 1.500 cc. . | Perioperative | 
| Operation duration | The operation duration was the time interval from skin incision to closure (hours) and classified into < 3 hours and > 3 hours. | Perioperative | 
| Number of Patients Admitted to ICU | ICU admission was identified by the documentation of number of patients' admission to the ICU | 24 hours | 
| Rate of Intraoperative complications | Rate of intraoperative complications were identified by the documentation of injury to adjacent structures (bladder or ureter) or a need for transfusion. | Intraoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intraoperative Bleeding in JSICA compared to hysterectomy | Intraoperative bleeding in this study was measured by the amount of blood loss (cc) and classified into < 1.000 cc, 1.000-1.500 cc, and > 1.500 cc in comparison of JSICA to hysterectomy | Perioperative | 
| Operation duration in JSICA compared to hysterectomy | The operation duration was the time interval from skin incision to closure (hours) and classified into < 3 hours and > 3 hours in comparison of JSICA to hysterectomy | Perioperative | 
| Number of Patients Admitted to ICU in JSICA compared to hysterectomy | ICU admission was identified by the documentation of number of patients' admission to the ICU in comparison of JSICA to hysterectomy | 24 hours | 
| Rate of Intraoperative complications in JSICA compared to hysterectomy | Rate of intraoperative complications were identified by the documentation of injury to adjacent structures (bladder or ureter) or a need for transfusion in comparison of JSICA to hysterectomy | Perioperative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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JSICA technique, Placenta Accreta, Uterine Preservation