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

Abstract

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. 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 (CG: 6 patients). For the CSG, our team adapted the approach described in previous research by Palacios-Jaraquemada. 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 = 0.159). The mean decrease in haemoglobin (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 = 0.240). The mean number of transfused red blood cell (RBC) units was 3 ± 3.2249 in the CG group and 1.5 ± 1.64317 in the CSG group (p = 0.334). The estimated blood loss between the two groups is not statistically significant. The required sample size is 22 patients.