of 60 pregnant female diagnosed as placenta previa accreta recuirted from Obstetrics and Gynecology Department , Menoufia University Hospital.

Placenta Accreta

Classical CS to decrease haemorrhage from placental bed.
Delievery of the fetus.
At the delivery 10 UI of oxytocin IV will be injected.
The placenta is not attempted to be delievered.
Opening of the broad ligament via round ligament division and ligation.
Gentle dissection of the urinary bladder from lateral to medial.
Bilateral uterine artery clamping at low level below the placental bed .
Gentle attempt to deliver The placenta.
If the placenta is delievered we will do bilateral uterine artery ligation at multiple levels and multiple square compression sutures(if needed) for proper hemeostasis at the placental bed. Then closure of uterine incision.
If the placenta is not delievered we will do segmental ressection of lower uterine segment including the placenta .
Intraperitoneal drain insertion.

Novel Technique of Placenta Accreta in Menoufia University Hospital

Menoufia University hospital

Hamed Elsayed Ellakwa

Conservative Surgical Novel Technique of Placenta Accreta in Menoufia University Hospital

control of bleeding and need for removal of uterus.

Amount of blood loss ,Number of packed red blood cells and blood products transfusion.

urinary bladder injury, ureteric injury. Postoperative complications e.g ileus, sepsis

Dr Hamed Ellakwa

Professor Hamed Ellakwa

Menoufia Obstetrics and Gynecology Group

Women assigned to prophylactic NPWT will have the PICO device applied and secured with fixation adhesion strips. The device will be monitored while the patient is in the hospital to confirm that it is functioning well. The device will be removed prior to discharge, typically on postoperative day 4.

Women assigned to standard care will receive routine postoperative wound dressing consisting of layers of gauze and adhesive tap. The dressing will be removed after 24 - 48 hours.

Women assigned to prophylactic NPWT had the PICO device applied and secured with fixation adhesion strips. The device was monitored while the patient is in the hospital to confirm that it is functioning well. The device was removed prior to discharge, typically on postoperative day 4.
Prophylactic NPWT (PICO system): The PICO NPWT system is a small, lightweight (~126 grams), portable suction device consisting of an electric motor-driven vacuum pump connected to a proprietary super-absorbent adhesive dressing. It is supplied as a pump with two sterile dressing kits and two batteries. Different dressing sizes are available for transverse and vertical incisions ranging from 10 to 40 cm. The PICO pump maintains negative pressure of -80 mmHg (+/-20 mmHg) to the wound surface.

Prophylactic NPWT

Women assigned to standard care had routine postoperative wound dressing consisting of layers of gauze and adhesive tap. The dressing was removed after 24 – 48 hours.
Standard Dressing: Standard wound dressing consists of routine postoperative wound dressing consisting of layers of gauze and adhesive tape.

Standard Dressing

Total

Sex: Female, Male

Ethnicity (NIH/OMB)

Race (NIH/OMB)

Region of Enrollment

Body mass index

Scheduled cesarean

Superficial or deep SSIs or other wound complications (separation, hematoma, seroma) after cesarean. SSI will be defined according to the Centers for Disease Control (CDC) criteria as infections at the surgical site occurring within 30 days of cesarean delivery, and classified as superficial, deep, or organ/space occupying.

Prophylactic Negative Pressure Wound Therapy (NPWT)

Number of Participants With Composite Surgical Site Infection (SSI) or Other Wound Complication.

Proportion of Participants with Surgical site infection; Proportion of Participants with wound separation; Proportion of participants with hematoma; Proportion of participants with seroma.

Women assigned to prophylactic NPWT had the PICO device applied and secured with fixation adhesion strips. The device was monitored while the patient was in the hospital to confirm that it wass functioning well. The device will be removed prior to discharge, typically on postoperative day 4.
Prophylactic NPWT (PICO system): The PICO NPWT system is a small, lightweight (~126 grams), portable suction device consisting of an electric motor-driven vacuum pump connected to a proprietary super-absorbent adhesive dressing. It is supplied as a pump with two sterile dressing kits and two batteries. Different dressing sizes are available for transverse and vertical incisions ranging from 10 to 40 cm. The PICO pump maintains negative pressure of -80 mmHg (+/-20 mmHg) to the wound surface.

Number of Participants With Any COMPONENT of SSI or Composite Wound Complication

Participant pain scores on postoperative day 2 on a 0 (minimum) to 10 (maximum) 0n Likert Scale, where 0 is no pain and 10 is the worse pain. Higher score means worse outcome

Pain Score on a 0 to 10 on Likert Scale

Rate of positive wound culture in participants with SSI after cesarean.

Number of Participants With Positive Wound Culture

Rate of methicillin-resistant Staphylococcus aureus in patients with SSI after cesarean.

Number of Participants With Methicillin-resistant Staphylococcus Aureus.

Rate of composite of adverse events potentially attributable to NPWT including skin blisters, erythema, wound bleeding.

Number of Participants With Any Prophylactic Negative Pressure-related Adverse Events.

Overall Study

Methodius Tuuli

Wound Infections

The PICO NPWT system is a small, lightweight (~126 grams), portable suction device consisting of an electric motor-driven vacuum pump connected to a proprietary super-absorbent adhesive dressing. It is supplied as a pump with two sterile dressing kits and two batteries. Different dressing sizes are available for transverse and vertical incisions ranging from 10 to 40 cm. The PICO pump maintains negative pressure of -80 mmHg (+/-20 mmHg) to the wound surface.

Prophylactic NPWT (PICO system)

Standard wound dressing consists of routine postoperative wound dressing consisting of layers of gauze and adhesive tape.

endometritis/edema

Conservative Surgical Novel Technique of Placenta Accreta in Menoufia University Hospital

Prophylactic Incisional Care in Obese Women at Cesarean

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