Effectivness of Conservative Techniques in Management of PAS

• Conditions: Placenta Accreta

• Registration Number: NCT05104177
• Lead Sponsor: Assiut University

Brief Summary

To evaluate the effectiveness of conservative techniques for placenta accreta spectrum to reduce maternal mortality and morbidity

Detailed Description

Placenta accreta spectrum (PAS) represents the spectrum of clinical conditions when part or whole of the placenta becomes abnormally adherent or invades the myometrium . Over the last 40 years, caesarean delivery rates around the world have risen from less than 10% to over 30%, and almost simultaneously a 10-fold increase in the incidence of PAS . PAS is one of the most dangerous conditions of the pregnancy as it is significantly associated with maternal morbidity and mortality .

Ultrasound imaging is the most commonly used technique to diagnose PAS disorders prenatally. There is also wide variation globally on the management of PAS disorders, with some centres opting for a radical approach, whereas others have proposed a range of conservative approaches .

The conservative approaches include one-step conservative surgery, leaving the placenta in situ, the Triple-P procedure, and transverse B-Lynch suture . Recently, Women's health hospital has adopted a new approach for conservative management of most cases of PAS, including wedge resection of the myometrium over the adherent part of the placenta, or a staged-approach following delivery of the fetus starting with meticulous dissection of the urinary bladder form the lower uterine segment, then bilateral uterine artery ligation at a level below the apparent placenta-myometrial bulge, followed by removal of the placenta, after which a catheter is inserted in the cervix and the placental pouch is closed .

Study Timeline

• Study First Submitted: 2021-10-09
• Status Verified: 2021-11
• Study Start: 2021-11
• Study First Submitted QC: 2021-11-01
• Study First Posted: 2021-11-02
• Last Update Submitted: 2021-11-02
• Last Update Posted: 2021-11-09
• Primary Completion: 2022-11
• Study Completion: 2022-12

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: Female
• Target Recruitment: 80

Inclusion Criteria

1. • Gestational age starting from 28 weeks onwards.
2. • Women with at least 1 previous hysterotomy (e.g. Caesarean deliveries, myomectomy)
3. • Elective or emergent Caesarean deliveries

Exclusion Criteria

• A pre-existing decision of performing intrapartum hysterectomy

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
number of patients who undergo hysterectomy after failure of conservative techniques	baseline	Counting patients who undergo hystrectomy after conservative techniques to evalute it's effectivness

Secondary Outcome Measures

Name	Time	Method
recurrence of PAS	baseine	Nomber of cases recurrence who will have of PAS In subsequent pregnancies after conservative techniques