Overview
study will be carried out on patients with placenta accreta spectrum having done uterine conservation and recording immediate outcome of conservation regarding success of the procedure, amount of blood loss and amount of blood transfused and followed up to check the return of menses, any uterine abnormalities by ultrasound or hysteroscopy especially isthmocele and intrauterine synechia.
Description
After institutional review board approval and written informed consent, recruited cases will be subjected to the following:
- Data registration including:
- Age.
- Obstetric history including gravidity, parity, number of previous cesarean deliveries, and number and gender of living children.
- Details of the current pregnancy including duration in menstrual weeks, any problems encountered during its course.
- Desire for future fertility.
- Medical, surgical, and medication history.
- Anthropometry including weight, height, and body mass index (BMI) before pregnancy and at the time of operation.
- General examination including vital signs, and signs of any associated problems.
- Routine laboratory investigations with particular emphasis on complete blood count, Coagulation profile and including blood glucose level, renal and liver function tests.
- Detailed sonographic examination to evaluate fetal biometry, and wellbeing rule out exclusion factors, and confirm diagnosis of PAS and assess the degree of invasion, and its severity using both trans-abdominal transducer with frequency of 2-5 megahertz (MHZ) and trans-vaginal transducer with frequency of 4-10 MHZ.
Intraoperative details will be documented. Follow up of patients will be recorded. Sample size was calculated by estimating a single proportion distribution at a significance level of 0.05.
Eligibility
Inclusion Criteria:
- • Diagnosed sonographically to have placenta accreta spectrum.
- Pregnancy is singleton and fetus is alive.
- Elective caesarean section done from 35 gestational weeks.
Exclusion Criteria:
- • Patients requesting hysterectomy.
- Coexisting uterine pathology such as fibroids or gynaecological malignancies.
- Patients with bleeding diathesis.
- Morbid obesity of BMI \>40.
- Patients having labour pains or vaginal bleeding before scheduled intervention.
