Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT04215484 |
Other study ID # |
BNP-ACCRETA |
Secondary ID |
|
Status |
Completed |
Phase |
|
First received |
|
Last updated |
|
Start date |
January 2, 2020 |
Est. completion date |
May 30, 2020 |
Study information
Verified date |
April 2021 |
Source |
University Tunis El Manar |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Observational [Patient Registry]
|
Clinical Trial Summary
The placenta accreta is defined as a placenta that is abnormally adherent to the myometrium.
It can thus invade the entire thickness of the myometrium (placenta increta) or even exceed
the serosa and invade neighboring organs (placenta percreta). It is a rare obstetric
pathology with significant morbidity, and its management most often requires hemostatic
hysterectomy. Its frequency has increased significantly in recent decades due to the
increased rate of caesareans.
The maternity center of Tunis ( CMNT ) is a level 3 maternity center, supporting over 12 000
births yearly, where the caesarean section's rate is very high, close to 45% of deliveries.
Recently we noted an increase in abnormal placental invasion incidence : in 2018, we report
over 60 cases of placenta accreta,increta and percreta.
Early detection of these patients can help reduce potential risks. Ultrasound and MRI are the
main diagnostic tools, but each one has weaknesses. Biological approch of this diagnosis is
not well studied. Recently, BNP has been shown to be associated with increased angiogenesis.
Because placenta accreta is characterized by abnormal uteroplacental neovascularization, it
has been hypothesized that serum BNP levels may be related to abnormal invasion of the
placenta.
In the literature, only one study investigated the relationship between cardiac biomarkers
(Pro-BNP, CK, CK-MB and troponins) and abnormalities of placental adhesion. The main
conclusion was that the Pro-BNP could predict placental accretisation.
Thus, the BNP as a mean of screening, could enrich our diagnostic arsenal. The purpose of our
study is to determine whether or not BNP can predict abnormal placental invasion during
pregnany.
Description:
The investigators will conduct a monocentric , prospective, observational study, including 60
pregnant women, with history of at least one previous uterine scar, and scheduled for
cesarian delivery. The participants will be divided into 3 equal groups according to the
imaging data obtained by a senior ultrasonographer , and the MRI data when necessary :
Ultrasonography will be performed in all participants. If placenta previa is diagnosed,
without any suggestive signs of abnormal placental invasion, the patient is assigned to group
P.
If placenta previa is diagnosed, and associated to suggestive signs of abnormal placental
invasion,the patient is assigned to group I and an MRI will be performed.
If the ultrasonography is free of any suggestive signs of placenta previa, the patient is
assigned to group N.
Finally :
- group P : pregnant women with placenta previa on ultrasound and no suggestive signs of
abnormal placental invasion
- group I : pregnant women with placenta previa on ultrasound, and suggestive signs of
abnormal placental invasion on ultrasound .
- group N : pregnant women without suggestive signs of placenta previa or abnormal
placental invasion on ultrasound
After written and informed consent are obtained, a standard battery of blood tests including
serum BNP will be runned.
For every patient, the following will be recorded : anthropometric measurements, previous
obstetric and medical history, emergency or elective surgery, anesthetic technique,
per-operative findings (placenta previa, placenta previa with abnormal placental invasion
(accreta, increta, percreta), placenta normally located), amount of blood products
transfused, nature of haemostasis procedures, complications.
Patients will be excluded, if their condition may cause a rise in serum BNP during the sample
collection, those being: preterm premature rupture of membranes, acute anaemia or
metrorrhagia, active labor, severe infections, arterial hypertension, known pulmonary
hypertension, symptoms of heart failure, known hypertrophic or restrictive cardiomyopathy,
history of valvular or congenital heart disease, atrial and ventricular tachyarrhythmias,
pulmonary embolism, chronic obstructive pulmonary disease, kidney failure or renal
dysfonction, liver dysfonction, severe metabolic and hormone abnormalities ( thyrotoxicosis
or diabetic ketosis ), drug use possibly affecting cardiovascular system ( beta-blocker or
other cardiovascular drug).
ANESTHETIC MANAGEMENT:
The timing of delivery is usually between 36 and 37 weeks for group P and I, and after 38
weeks for group N.
General anesthesia will be performed in pregnant women from group I and P. Regional
anesthesia will be performed in pregnant women from group N.
Hemodynamic management during anesthesia for group I will require placement of 2 peripheral
large-bore venous access, a desilet catheter in the femoral vein, and an arterial line
preoperatively.
In patients from group P, 2 peripheral large-bore venous access will be placed
preoperatively. A desilet catheter and arterial line will be obtained if necessary upon the
anesthesiologist judgment.
In patients from group N, 1 peripheral large-bore venous access will be placed prior to the
beginning of surgery.
Blood transfusion requirements will be based on the hemodynamic status, the amount of blood
loss, the need of catecholamines and the anesthesiologist's experience.
Peroperatively, final diagnosis will be made according to surgical findings. If placenta is
completely and easily removed, the diagnosis of abnormal placental invasion will not be
retained.
If placenta could not be easily and completely removed, the diagnosis of abnormal placental
invasion in established, and the case is carried out according to our surgical and anesthetic
standards of management.
After collecting all groups, blood samples will be analysed for BNP, in a unique serie of
tests.