Placenta Accreta Spectrum Clinical Trial
Official title:
MOGGE PAR-A and PAR-P Scores for Prediction of Adverse Outcomes of Placenta Accreta Spectrum: A Multi-center International Validation Study Protocol
Placenta accreta spectrum (PAS) is a set of placentation disorders that are associated with
trophoblastic invasion through the physiologic decidual-myometrial junction zone. PAS may be
associated with massive obstetric hemorrhage, surgical injuries, maternal intensive care unit
(ICU) admission, reoperation, and prolonged hospitalization.
This study aims at estimating the validity of "MOGGE placenta accreta risk-antepartum score"
or "MOGGE PAR-A score" in predicting potential outcomes once PAS is diagnosed antenatally. In
addition, it evaluates the validity of "MOGGE placenta accreta risk-peripartum score" or
"MOGGE PAR-P score" in calculating the probability of the same outcomes using baseline
features in conjugation with both disease-and surgery-related peripartum
variables,thereby,assist designation of the most suitable management. Finally , MOGGE CON-PAS
score was created for the subgroup of women who were subject to conservative management to
predict probability of uterine preservation success.
Incidence of PAS has significantly increased in concordance with rising trend of cesarean
section delivery (CS) among contemporary population.
Although cesarean hysterectomy, without trying to separate placenta (placenta in-situ), is
the standard management of PAS, uterine preservation may be routinely offered to women who
are concerned about preserving their uteri and may be considered the primary approach in many
institutes all over the world.
The "Placenta Accreta Spectrum International Database (PAS-ID)" is an international database
that was launched by Middle-East Obstetrics and Gynaecology Graduate Education (MOGGE)
Foundation to conduct the current study.
Eligible patients ,with criteria mentioned in following sections, will be counseled on
participation by one of the research team. They will be added to study database by an
independent investigator(observing investigator) who will collect baseline data and calculate
MOGGE PAR-A score using MOGGE PAR score 1.0 software (available at:
https://www.mogge-obgyn.com/clinical-studies). The observing investigator will continue to
collect clinical data in subsequent visits, through delivery and postpartum visit to
calculate MOGGE PAR-P score at the end of follow-up. If patient management involves a uterus
preserving procedure, MOGGE CON-PAS score will be calculated as well(it will be available at:
https://www.mogge-obgyn.com/clinical-studies). The observing investigator should not be a
part of patients'clinical care team, which should be blinded to the calculated scores. data
will be collected using an excel spreadsheet designed for this study. Concerned data include
patient age, parity, body mass index,smoking, ethnicity, previous gynecologic surgeries,
obstetric complications, gestational age at diagnosis and delivery(in weeks), method of
diagnosis, administration of antenatal steroids, indication of delivery, pre-delivery and
post-delivery hemoglobin (g/dl), operative management, placental site, degree of placental
invasion, type of cesarean incision and its relation to the placenta, intra-operative and
postoperative complications, intra-operative blood loss in ml, and transfusion of blood
products
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