Surgical Management of Placenta Accreta Spectrum Disorders Using Total Lower Segmentectomy With Cervico-Corporeal Anastomosis and Adjunctive Mechanical Towel Compression

Surgical Management of Placenta Accreta Spectrum Disorders Using Total Lower Segmentectomy With Cervico-Corporeal Anastomosis and Adjunctive Mechanical Towel Compression: A Case Series

The goal of this observational study is to evaluate the feasibility and safety of utilizing adjunctive mechanical towel compression during TLS-CCA, measured primarily by estimated intraoperative blood loss in patient with Maternal age 18-45 years - Singleton pregnancy - Antenatal diagnosis of PAS (ultrasound ± MRI) - Planned elective cesarean delivery - Candidate for uterine preservation via TLS-CCA - Provided written informed consent

Study Overview

• Status: Not yet recruiting
• Conditions: Placenta Accreta Management

Detailed Description

Placenta accreta spectrum (PAS) disorders, characterized by abnormal trophoblastic invasion into the myometrium, have seen a global rise in incidence primarily driven by increasing cesarean delivery rates. Massive obstetric hemorrhage remains the leading cause of maternal morbidity and mortality in these cases.

While cesarean hysterectomy is the traditional gold standard for severe PAS, uteruspreserving procedures are increasingly preferred by patients desiring future fertility. Total lower uterine segmentectomy with cervico-corporeal anastomosis (TLS-CCA) is a recognized conservative technique that involves excising the invaded lower segment and reconstructing the uterus. Despite removing the primary placental implantation site, diffuse bleeding from the highly vascularized remaining myometrial bed, dissected bladder flap, and pelvic collateral vessels often persists. While traditional compression sutures or specialized devices are utilized for hemostasis, they can be costly or technically challenging in distorted anatomies. This study introduces a novel, simple, and cost-effective approach: the use of tightly rolled sterile surgical towelsapplied as direct mechanical compression against the lower uterine segment and bladder bed during dissection and reconstruction.

• Study Type: Observational
• Enrollment (Estimated): 30

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Probability Sample

Study Population

A consecutive series of pregnant women with an antenatal diagnosis of PAS scheduled for elective, uterus-preserving surgical management via TLS-CCA utilizing the novel towel compression technique

Description

Inclusion Criteria:

• Maternal age 18-45 years
• Singleton pregnancy
• Antenatal diagnosis of PAS (ultrasound ± MRI)
• Planned elective cesarean delivery
• Candidate for uterine preservation via TLS-CCA
• Provided written informed consent

Exclusion Criteria:

• Hemodynamic instability necessitating emergency hysterectomy
• Placental invasion into adjacent pelvic organs requiring exenteration
• Pre-existing severe coagulation disorders
• Multiple gestation or major fetal anomalies
• Patient refusal to participate

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Estimated intraoperative blood loss	Estimated intraoperative blood loss by (mL)	at operation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Blood transfusion requirements	Blood transfusion requirements (units of packed RBCs and FFP)	intraoperative

Collaborators and Investigators

• Sponsor: Assiut University

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): September 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: July 10, 2026
• First Submitted That Met QC Criteria: July 10, 2026
• First Posted (Actual): July 15, 2026

Study Record Updates

• Last Update Posted (Actual): July 15, 2026
• Last Update Submitted That Met QC Criteria: July 10, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: placenta accreta
• Additional Relevant MeSH Terms: Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Obstetric Labor Complications; Pregnancy Complications; Placenta Diseases; Placenta Accreta
• Other Study ID Numbers: Nourhan