New Conservative Technique for Placenta Accreta Spectrum

NCT ID: NCT04427592

Last Updated: 2023-12-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

159 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-07-28

Study Completion Date

2023-05-20

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Placenta Accreta Spectrum

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Investigators conducting prospective study for management of placenta accreta spectrum including diagnosis and uterine sparing surgery.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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pregnant women with placenta accreta spectrum

The participants were subjected to ultrasound to diagnose placenta accreta spectrum followed by new conservative surgical technique.

Group Type EXPERIMENTAL

ultrasound

Intervention Type DIAGNOSTIC_TEST

trans-vaginal and trans-abdominal ultrasound using different modalities such as grey-scale, Doppler, multi-planer mode

closure of uterine wall defect

Intervention Type 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.

Interventions

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ultrasound

trans-vaginal and trans-abdominal ultrasound using different modalities such as grey-scale, Doppler, multi-planer mode

Intervention Type DIAGNOSTIC_TEST

closure of uterine wall defect

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.

Intervention Type PROCEDURE

Other Intervention Names

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Double compression suture

Eligibility Criteria

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Inclusion Criteria

* pregnant women diagnosed as placenta accreta spectrum with previous Cesarean section, with or without other uterine surgeries and less than 40 years of age.

Exclusion Criteria

* pregnant women having medical conditions such as cardiac diseases, coagulopathy and hematological disorders.

pregnant women had 5 or more previous Cesarean sections or their age more than 40 years
Minimum Eligible Age

19 Years

Maximum Eligible Age

40 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Alexandria University

OTHER

Sponsor Role lead

Responsible Party

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Mahmoud A Hamdy

principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mahmoud AH Hamdy, A. lecturer

Role: PRINCIPAL_INVESTIGATOR

faculty of medicine department of obstetrics and gyneacology

Locations

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Faculty of Medicine

Alexandria, , Egypt

Site Status

Countries

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Egypt

References

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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.

Reference Type RESULT
PMID: 29405320 (View on PubMed)

Other Identifiers

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H.R501

Identifier Type: -

Identifier Source: org_study_id