RecruitingNot ApplicableNCT07025954

Planned Delivery at 37 Versus 36 Weeks in Pregnancies With Placenta Previaand Accreta

Planned Delivery at 37 Versus 36 Weeks in Pregnancies Complicated byPlacenta Previa and Accreta: A Randomized Controlled Trial

Sponsor

The Third Affiliated Hospital of Guangzhou Medical University

Enrollment

600 participants

Start Date

Jul 12, 2025

Study Type

INTERVENTIONAL

Conditions

Placenta Previa Placenta Accreta Spectrum Antepartum Bleeding

Summary

Current clinical practice guidelines recommend planned cesarean delivery(CD) at 34-37 weeks of gestation in pregnant women with placenta previa and accreta. Preterm birth may lead to neonatal immaturity, while laterCD may increase the risk of severe hemorrhage and surgery complications. Retrospective studies have shown that indicated CD occurs in approximately1/3 of patients before 36 weeks, with the main trigger being antepartum hemorrhage. However, the risk of antepartum hemorrhage is lower after 36 weeks. Recent study showed that delivery shifted from 34-36 weeks to 37 weeks did not increase therisk of maternal intraoperative/postoperative hemorrhage and emergency CD. To further validate this, we propose to conduct a randomized controlled study comparing the effect of planned delivery management strategies at 37 0/7-37 6/7 weeks of gestation with those at 36 0/7-36 6/7 weekson maternal and fetal outcomes. The aim of this study is to explore whether planned delivery up to 37 weeks in pregnant women with placenta previa and accreta improves neonatal outcomes without increasing maternal obstetric risks.

Eligibility

Sex: FEMALEMin Age: 18 YearsMax Age: 45 Years

Inclusion Criteria4

-34 weeks of gestation.
Both ultrasound and MRI indicate placenta previa with placenta accreta spectrum (PAS).
Planned to undergo cesarean delivery at the participating study hospitals.
Agree to participate and sign the informed consent form.

Exclusion Criteria4

Multiple gestation.
Other obstetric complications (e.g., preeclampsia, vasa previa), and severe maternal medical conditions (e.g., uncontrolled diabetes, progressive cardiovascular disease, active systemic lupus erythematosus, liver cirrhosis).
Major uterine structural anomalies (e.g., uterine didelphys, Uterine tumors ≥5 cm).
Estimated fetal weight <3rd percentile for gestational age, major congenital anomalies, intrauterine fetal demise.

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Interventions

PROCEDURECesarean delivery

All patients were delivered via cesarean section with standardized perioperative management, including preoperative preparation (e.g., autologous bloodreserve, corticosteroid administration for foetal lungmaturation, etc.), surgical approach, and postoperative care. Conservative management (intentional placental retention in situ with local resection and pelvic devascularization) was primarily employed, while peripartum hysterectomy was reserved for those with extensive invasion or failed conservative treatment.