The study will compare a modified surgical approach for preserving fertility and minimizing hemorrhage in morbidly adherent placenta during cesarean section with a cervical tourniquet against uterine artery ligation.
Diagnosed sonographically to have placenta accreta spectrum .
Pregnancy is singleton and fetus is alive.
Elective caesarean section done from 36 gestational weeks
Patients requesting hysterectomy
Coexisting uterine pathology such as fibroids or gynaecological malignancies
Patients with bleeding diathesis.
Morbid obesity of BMI >40.
Parallel
cervical tourniquet
Procedure/SurgeryAfter opening the abdominal wall, To reduce bleeding during PAS, make the uterine incision above the placenta's intrauterine borders . 2-investigators extract the uterus from the abdomen 3-An assistant slides a sterile Foley catheter (Ch 16/18 French) down to the lowest point and secures it "en bloc" around the cervix 4-The bladder peritoneum is isolated from the uterus 5-To remove myometrial tissue, leave a margin of at least 2 cm superior to the cervical internal ostium using electrocautery or scissors .
uterine artery ligation
Procedure/SurgeryAfter opening the abdominal wall, To reduce bleeding during PAS, make the uterine incision above the placenta's intrauterine borders . 2-investigators extract the uterus from the abdomen 3-The bladder peritoneum is isolated from the uterus 4-The uterine vessels were ligated in continuity at the level of the utero-vesical fold on each side 5-To remove myometrial tissue, leave a margin of at least 2 cm superior to the cervical internal ostium using electrocautery or scissors .
operation time
recording total time of the surgery
repair time
recording length of defect repair from placental separation until uterine wall closure
Estimated blood loss
recording amount of blood loss
packed red blood cells transfusion
recording amount of red blood cell transfused
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