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A stepwise surgical approach for conservative management of placenta previa accreta.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Any age and parity with placenta accreta spectrum | Experimental | 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 |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| conservative surgery for uterus in placenta accreta | Procedure | 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 |
| Measure | Description | Time Frame |
|---|---|---|
| incidence rate of conserving woman's uterus | success rate of conservative surgery for placenta accreta | intraoperative |
| 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 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| mahmoud ghaleb, lecturer | ainshams university faculty of medicine | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ain SHams Maternity Hospital | Cairo | Abbaseya | Egypt |
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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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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 |
| D010922 | Placenta Diseases |