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This study for the conservative management of placenta accreta spectrum disorders (PAS), which are a major cause of maternal morbidity and mortality. The most common management strategy for PAS in the United States is a preterm cesarean-hysterectomy. However, accumulating data show that conservative management is safer and is preferred by some patients. In selected participants (n=15) who desire uterine preservation, the investigators provide the option of conservative management, which will be defined as leaving the placenta in the uterus after delivery of the infant. This is a single-arm single-site pilot study where all participants will be carefully monitored during a standard postpartum inpatient stay and with outpatient follow-up until the uterus is empty.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Uterine preservation | Experimental | Conservative management of PAS with the inclusion of antibiotics and uterine artery embolization, followed by close monitoring. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Conservative/Expectant Management | Other | At time of caesarean section, participants will not have a hysterectomy, but will be treated clinically to preserve their uterus. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Hysterectomy rate | Percent of participants who undergo a hysterectomy | Delivery through 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Endometritis rate | Percent of participants who have endometritis | Delivery through 1 year |
| Coagulopathy rate | Percent of participants who have coagulopathy |
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Inclusion Criteria:
Exclusion Criteria:
• Have a low antenatal suspicion for PAS based on imaging.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Beth Pineles, MD Phd | Contact | 267-226-7933 | beth.pineles@pennmedicine.upenn.edu | |
| Meaghan McCabe, MPH | Contact | meaghan.mccabe@pennmedicine.upenn.edu |
| Name | Affiliation | Role |
|---|---|---|
| Beth Pineles, MD PhD | University of Pennsylvania | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital of the University of Pennsylvania | Recruiting | Philadelphia | Pennsylvania | 19104 | United States |
Individual participant data will not be shared given the extremely small sample size and risk of participant identification
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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 |
|---|---|
| D057832 | Watchful Waiting |
| ID | Term |
|---|---|
| D017063 | Outcome Assessment, Health Care |
| D010043 | Outcome and Process Assessment, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
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| Delivery through 1 year |
| Frequency of vaginal bleeding | Percent of participants with vaginal bleeding at each time point | Delivery through 1 year |
| Frequency of pelvic pain | Percent of participants with pelvic pain at each time point | Delivery through 1 year |
| D010922 | Placenta Diseases |