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Evaluating a novel approach to placenta accreta spectrum management: the modified Triple-P technique with cystoinflation (a randomized controlled trial)
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Evaluating a novel approach to placenta accreta spectrum management: the modified Triple-P technique with cystoinflation (a randomized controlled trial)
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Journal Article
Evaluating a novel approach to placenta accreta spectrum management: the modified Triple-P technique with cystoinflation (a randomized controlled trial)
2025
Overview
Placenta accreta spectrum (PAS), or morbidly adherent placenta, is a life-threatening condition requiring caesarean section (C-section) and often hysterectomy due to massive postpartum haemorrhage. The widely adopted conservative management—the Triple-P procedure—carries a risk of substantial blood loss. Modifications like blunt bladder dissection and haemostatic suturing can help control bleeding however, bladder injury remains a concern, as identifying vesicouterine planes can be difficult among placental and prior C-sections adhesions. While some studies have used Cystoinflation (retrograde bladder filling) to delineate bladder edges in complex C-sections, its efficacy in preventing bladder injury during PAS surgeries is inconclusive, and no trial has evaluated its integration with the Modified Triple-P technique. To address this gap, we conducted a single-centre, single-blinded controlled trial with 150 women with PAS confirmed during C-section. Participants were randomised to either Modified Triple-P alone or the combined approach with Cystoinflation. Bladder injury, the primary outcome, occurred in 2 (2.7%) of the Cystoinflation group versus 14 (18.7%) of the controls (
P
< .0001). Secondary outcomes, including blood loss, hysterectomy rates, urologic complications, neonatal outcomes, and fertility, also favoured the combined approach. These results suggest adding Cystoinflation to Modified Triple-P enhances bladder safety and optimises maternal and foetal outcomes in PAS management.
Trial registration
This trial is a part of project “Cystoinflation to Prevent Bladder Injury in Obstetrics and Gynaecology Surgery” with ethical approval from King Edward Medical University. Trial Registration NCT04302545.
Publisher
Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
Subject
/ 692/1807
/ 692/308
/ 692/4025
/ 692/4028
/ 692/499
/ 692/700
/ Adult
/ Bladder
/ Blood
/ Blood Loss, Surgical - prevention & control
/ Cesarean Section - adverse effects
/ Female
/ Humanities and Social Sciences
/ Humans
/ Injuries
/ Neonates
/ Placenta
/ Postpartum Hemorrhage - surgery
/ Science
/ Surgery
/ Urine
/ Uterus
