New surgical technique for managing placenta accreta spectrum and pilot study of the "CMNT PAS" study

Hassine Saber Abouda; Haithem Aloui; Eya Azouz; Sofiene Ben Marzouk; Hatem Frikha; Rami Hammami; Sana Minjli; Rachid Hentati; Mehdi Khila; Badis Mohamed Chanoufi; Abir Karoui; Maghrebi Hayen

doi:10.1016/j.xagr.2024.100430

New surgical technique for managing placenta accreta spectrum and pilot study of the "CMNT PAS" study

AJOG Glob Rep. 2024 Dec 10;5(1):100430. doi: 10.1016/j.xagr.2024.100430. eCollection 2025 Feb.

Authors

Hassine Saber Abouda^{1

2}, Haithem Aloui^{1

2}, Eya Azouz^{1

3}, Sofiene Ben Marzouk^{1

4}, Hatem Frikha^{1

2}, Rami Hammami^{1

2}, Sana Minjli^{1

2}, Rachid Hentati^{1

2}, Mehdi Khila^{1

2}, Badis Mohamed Chanoufi^{1

2}, Abir Karoui^{1

2}, Maghrebi Hayen^{1

4}

Affiliations

¹ Tunis Medical Faculty, Tunis Centre for Maternity and Neonatal Care, Tunis El Manar University, Tunis, Tunisia (Abouda, Aloui, Azouz, Marzouk, Frikha, Hammami, Minjli, Hentati, Khila, Chanoufi, Karoui, and Hayen).
² Department "C" of Gynaecology and Obstetrics, Tunis, Tunisia (Abouda, Aloui, Frikha, Hammami, Minjli, Hentati, Khila, Chanoufi, and Karoui).
³ Department of Radiology, La Rabta, Tunis, Tunisia (Azouz).
⁴ Department of Anaesthesiology and Intensive Care, Tunis, Tunisia (Marzouk and Hayen).

Abstract

Introduction: The gold standard for treating the placenta accreta spectrum (PAS) is a cesarean hysterectomy, which harms fertility. Another conservative surgical approach allows the uterus to be preserved: one-step conservative surgery. We will compare these two approaches through the "CMNT PAS" study. Before this main study, we conducted a pilot study to determine the required sample size.

Study design: This pilot study, conducted over 31 months, included patients who underwent surgery for suspected PAS based on imaging findings. Participants were divided into the conservative surgery group (CSG: 6 patients) and the Caesarean Hysterectomy Group (control group [CG]: 6 patients). For the CSG, our team adapted the approach described in previous research by Palacios-Jaraquemada.

Results: The primary objective of our study is to ascertain the appropriate sample size for our main investigation on the conservative surgical management of PAS. Concerning the primary outcome, the estimated amount of blood loss was lower in CSG compared to CG, although this difference was not statistically significant (1298.04±556 mL vs 891.051±348 mL, P=.159). The mean decrease in hemoglobin (Δ Hb) was 2.8±1.3251 g/dL in the CG group compared to 1.933±1.0614 g/dL in the CSG group (P=.240). The mean number of transfused red blood cell units was 3±3.2249 in the CG group and 1.5±1.64317 in the CSG group (P=.334).

Conclusion: The estimated blood loss between the two groups is not statistically significant. The required sample size is 22 patients.

Keywords: conservative surgery; hysterectomy; massive hemorrhage; placenta accreta.