Conservative Surgery for Placenta Accreta

Not Applicable

Completed

Interventions: Procedure: conservative surgery for uterus in placenta accreta

Brief Summary: A stepwise surgical approach for conservative management of placenta previa accreta.

Detailed Description: 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.

Recruitment & Eligibility

Inclusion Criteria

Any age.
Any parity.
Previous one or more cesarean delivery.
Placenta previa accreta diagnosis confirmed by gray scale & color flow Doppler ultrasound in 3rd trimester. All participants had undergone abdominal ultrasound showing placenta previa anterior completely covering the internal os, with criteria suggestive of invasion by U/S

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Any age and parity with placenta accreta spectrum	conservative surgery for uterus in placenta accreta	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

Primary Outcome Measures

Name	Time	Method
incidence rate of conserving woman's uterus	intraoperative	success rate of conservative surgery for placenta accreta

Secondary Outcome Measures

Name	Time	Method
incidence rate of cesarean hysterectomy needed	intraoperative and 48 hours postpartum	failure of conservation , increase in blood loss
number of units of packed red blood cells , Fresh Frozen Plasma transfused ,postoperative haemoglobin	till 48 hours postpartum	to assess blood loss
incidence of puerperal sepsis	till 6 weeks postpartum	temperature chart every 6 hours in 1st 48 hours postpartum then follow up visits 2 weeks and 6 weeks postpartum

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