A randomized clinical trial comparing the cervico-isthmic compression suture versus lower anterior wall uterine resection in cases of the morbidly adherent anteriorly situated placenta

Abstract

Objective: To evaluate the effectiveness and safety outcome of cervico-isthmic compression suture compared to lower anterior wall uterine resection in preserving fertility and minimizing blood loss in cases of anterior situated morbidly adherent placenta. Methods: the study was conducted at Mansoura University Hospitals, Mansoura, Egypt during October 2020 to November 2022. A total number of 74 patients with morbidly adherent placenta fulfilled the inclusion criteria and were enrolled and divided into two equal groups. GA, cervico-isthmic compression suture group and GB, lower uterine wall resection group. The main primary outcome measures were intraoperative complications, need for blood or its elements transfusion and emergent hysterectomy, while the secondary outcome measures involved the occurrence of postpartum hemorrhage (PPH) and need for ICU admission as well as neonatal outcome. Results: the baseline characteristics showed no significance differences between both groups in maternal age, gravidity, parity, fetal gestational age, body mass index, number of previous vaginal or caesarean deliveries, number of previous abortions, ectopic pregnancies, preterm labor or history of gynecological operations as well as preoperative hemoglobin levels, (p>0.05). Despite the number is equal in both groups but there is a significant difference as regard the grade of accretion as grade I is found in 9 cases of GA vs 2 only in GB, whilst grade II was diagnosed in 28 cases in GA vs 35 cases in GB, (p<0.05). the mean estimated operative time showed no difference between both groups (p >0.05) but the mean estimated intraoperative blood loss and the need for packed RBCs transfusion appeared statistically significant between both groups being lower in GA compared to GB (p 0.001). Sixteen cases of GA were in need of internal iliac artery ligation (IIAL) vs 22 cases in GB, but this did not give any significance. The occurrence of postpartum hemorrhage, endometritis, need for emergent hysterectomy or ICU admission appeared similar in both groups. On the other hand, there is recorded statistical significance as regard bladder injury and mean hospital stay time being lower in GA than GB (p <0.05). The neonatal outcome demonstrated similar results in both groups with no evident of any neonatal complication or need for NICU admission. Conclusion: The use of cervico-isthmic compression suture appeared more effective and safer than lower uterine wall resection in cases of anteriorly located placenta accreta particularly in terms of intraoperative blood loss, blood transfusion, intraoperative bladder injuries and the postoperative hospital stay.