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participants diagnosed as placenta accreta spectrum were subjected to cesarean delivery.
Investigators manually detected a plan of cleavage through which the placenta was separated followed by closure of defective placental bed.
Data were collected about the outcome.
Demographic data, detailed history taking, routine blood tests were done. Trans-abdominal and trans-vaginal ultrasound to diagnose placenta accreta spectrum ( PAS). Detecting new signs to help sure diagnosis of PAS.
Cesarean section will be performed through extended transverse supra-pubic incision bladder dissection from anterior uterine wall using electro-coagulation instruments and double ligation of large caliber bridging vessels.
Uterine incision above the placental bulge by at least 5 mm then complete separation of the placenta starting from least resistance plans to high resistant one leaving a clear defect which will be closed by running sutures from inside the uterus and controlling placental bed hemorrhage then closing the uterine incision with compressing the bed from outwards ( double compression sutures ) internal Iliac artery ligation may be done as a complementary measure to control the bleeding from abnormal pelvic vasculature, insertion of intraperitoneal drain and closure of abdominal wall in layers.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| pregnant women with placenta accreta spectrum | Experimental | The participants were subjected to ultrasound to diagnose placenta accreta spectrum followed by new conservative surgical technique. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ultrasound | Diagnostic Test | trans-vaginal and trans-abdominal ultrasound using different modalities such as grey-scale, Doppler, multi-planer mode |
|
| Measure | Description | Time Frame |
|---|---|---|
| surgical outcome | number of participants whom their uterus were preserved without major hemorrhage | from the time of the surgery until 48 hours after. |
| intra-operative blood loss | the amount of blood loss during operation was estimated for each participant. | intraoperative |
| surgical complications | number of participants had bladder, ureter injury or hysterectomy, | intraoperative |
| internal iliac artery ligation | number of participants had with either unilateral or bilateral internal iliac artery ligation | intra-operative |
| high dependency unit admission | number of participants needed high dependency unit admission | from 0 to 48 hours postoperative |
| wound complications | number of patients suffered wound infection | up to 2 weeks postoperative |
| change in the hemoglobin level | participant's hemoglobin was measured | from 48 hours pre operative to 48 hours post operative |
| blood transfusion | number of units of blood and it's products transfused to participants |
| Measure | Description | Time Frame |
|---|---|---|
| placental bed | number of participants that investigators detected a well delineated placental bed like a pouch | intra-operative |
| pouch site | the site of the pouch in relation to the cervix |
| Measure | Description | Time Frame |
|---|---|---|
| new ultrasound sign the pouch | number of participants that the investigators detected the previously noticed pouch by ultrasound. | pre-operative |
| significance of the pouch | the investigators determine the relation of the pouch to estimated blood loss |
Inclusion Criteria:
Exclusion Criteria:
pregnant women had 5 or more previous Cesarean sections or their age more than 40 years
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| Name | Affiliation | Role |
|---|---|---|
| Mahmoud AH Hamdy, A. lecturer | faculty of medicine department of obstetrics and gyneacology | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of Medicine | Alexandria | 21131 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29405320 | Result | Sentilhes L, Kayem G, Chandraharan E, Palacios-Jaraquemada J, Jauniaux E; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management. Int J Gynaecol Obstet. 2018 Mar;140(3):291-298. doi: 10.1002/ijgo.12410. No abstract available. |
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all IPD that underlies results in publication
after publication by 1 month
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| ID | Term |
|---|---|
| D010921 | Placenta Accreta |
| ID | Term |
|---|---|
| D007744 | Obstetric Labor Complications |
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
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| ID | Term |
|---|---|
| D014463 | Ultrasonography |
| ID | Term |
|---|---|
| D003952 | Diagnostic Imaging |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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Investigators conducting prospective study for management of placenta accreta spectrum including diagnosis and uterine sparing surgery.
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| closure of uterine wall defect | Procedure | uterine incision above placental bulge by at least 5 mm then complete separation of the placenta starting from areas of least resistance to areas of high resistance leaving a clear defect which will be closed by non locked running sutures from inside the uterus starting from one edge, hitch the bed to the other edge of the defect and controlling placental bed hemorrhage then closing the uterine incision via running sutures in 2 layers with compressing the bed from outwards in the first layer. hemostasis of the abnormal pelvic vasculature if excessive bleeding internal iliac artery may be ligated then insertion of intra-peritoneal drain followed by closing the abdomen. |
|
|
| from 48 hours preoperative to 48 hours postoperative. |
| hematuria | number of participants suffered hematuria | post-operative up to 24 hours |
| manual cervical assesment | participants were subjected to vaginal examination to asses the cervix lenght | before skin incision |
| placental separation | number of participants whom their placenta was separated manually | intra-operative |
| surgical grading of the placenta | number of participants who had accreta, increta, percreta or mixed type | intra-operative |
| ultrasound grading of the placenta | number of participants who were diagnosed by ultrasound as accreta, increta or percreta | pre-operative |
| manual assessment of vaginal fornices | participants were subjected to vaginal examination to assess fornices | before skin incision |
| repair time | the time recorded from the end of the placental separation to the closure of the first layer of the uterus | intra-operative |
| total operation time | the time taken from the start of the skin incision to the skin closure | intra-operative |
| intra-operative |
| defect site | the location of the myometrium defects | intra-operative |
| peri-operative |
| Pathology | Histopathological examination of 1 cm specimen from the myometriam attached to the placenta in random cases | From the operation time for 48 hours |
| D010922 | Placenta Diseases |