Comparison Between 3 Conservative Surgeries for Placenta Accreta Spectrum

NCT07520201 | Not Yet Recruiting DMC

• 1 other identifier: MOSCUS
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 1

Brief Summary

Comparison between modified one-step surgery vs. Segment Resection vs. placental bed suturing for management of placenta accreta spectrum

Conditions

Placenta Accreta Spectrum

Keywords

Segment Resection; Modified one-step; Placental bed plication; Conservative uterine surgery

Outcome Measures

Primary Outcomes (1)

• Intraoperative Blood loss

  Increased blood loss means bad outcome

  24 hours

Study Arms (3)

Modified one-step surgery

EXPERIMENTAL

Procedure: Modified one-step surgery

Segment Resection

EXPERIMENTAL

Procedure: Segment Resection

Placental bed suturing

EXPERIMENTAL

Procedure: Placental bed suturing

Interventions

Modified one-step surgery PROCEDURE

transverse uterine incision is made at the upper border of the placenta without cutting through the placenta, then fetal delivery. A tourniquet is first put into the para-cervical area (using a Foley 12-F catheter) to stop active bleeding, and bilateral uterine artery ligation (using Chromic 1/0) is performed, followed by manual placental removal . Myometrial resection is performed if the remaining lower uterine segment of the healthy myometrium measures more than 2 cm. Suture of both edges of the uterine incision and hemostatic sutures of the placental bed surface (using chromic suture 1/0) are performed. Finally, the tourniquet is released and a transverse B-Lynch compression suture is made

Modified one-step surgery

Segment Resection PROCEDURE

transverse uterine incision was applied just above the upper border of involved uterine wall . And the fetus was extracted from this incision and the umbilical cord was clamped. In order to decrease hemorrhage, anterior branches of hypogastric arteries were ligated bilaterally. urinary bladder dissection from anterior uterine wall is done. Then the involved segment is resected by leaving placental free tissue medially to the uterine arteries, below transverse uterine incision and above the cervix. Resection was made by scissors or cautery and bleeding from the borders was controlled by ring forceps.

Segment Resection

Placental bed suturing PROCEDURE

After the separation of the placenta, all bleeding areas are clamped with several curved ovarian forceps. After the mechanical hemostasis of the lower uterine segment has been achieved, the remaining small amounts of placental fragments are removed by instrument. The clamps are removed sequentially, and the vesicouterine interface and all spaces are sutured with superficial stitches under the guidance of the surgeon's fingers. These superficial continuous sutures are not very deep. Cho sutures are used to achieve comlete hemostasis.

Placental bed suturing

Eligibility Criteria

• Sex: female
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• pregnant women with placenta accreta spectrum

You may not qualify if:

• Patients refuse to share in the study
• Pregnant \< 28 weeks

Sponsors & Collaborators

• Assiut University: lead

Study Sites (1)

Women's Health Hospital

Asyut, Egypt

Location

MeSH Terms

Conditions

Placenta Accreta

Condition Hierarchy (Ancestors)

Obstetric Labor Complications; Pregnancy Complications; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Placenta Diseases

Central Study Contacts

Mohammed Gamal, PhD

CONTACT

+20882312388; mohamedbeethoven2040@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Lecturer obstetric and gynecology, Specialist Urogynecology

Study Record Dates

• First Submitted: April 3, 2026
• First Posted: April 9, 2026
• Study Start: June 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): July 1, 2027
• Last Updated: April 9, 2026

Record last verified: 2026-04

Locations

EG (1)