Sub-endometrial injection of vasopressin to control bleeding in postpartum hysterectomy due to abnormally invasive placenta

Evaluation of the effectiveness of sub-endometrial injection of vasopressin for the postpartum bleeding in patients with placental accreta

Two-arm parallel group double blinded randomized trial, phase 3 for 60 patients, randomized by envelopes

After providing sufficient explanations and obtaining informed consent in Imam Khomeini hospital complex, Tehran, , the patients' initial data will be collected, and a distinct date for cesarean section will be determined. Participants will then be randomly assigned into intervention or control groups. For patients, ready-to-inject solutions are provided by the hospital pharmacy. The prepared solution for the intervention group is 20 ml in total, containing 1 ml of vasopressin, equivalent to 5 units, which is diluted in 19 ml of 0.9% normal saline. The solution prepared for the control group will also contain 20 ml of 0.9% normal saline. The only person who knows the contents of the solution is the pharmacist, and doctors do not know the contents of the syringes during the operation. After the intervention, the health care personnel will be also blinded.

Pregnant women with more than18 years of age, with diagnosis of placenta accarta according to ultrasound findings by a radiologist

For the intervention group, a total of 20 ml, containing 1 ml of vasopressin, equivalent to 5 units, diluted in 19 ml of normal saline 0.9% will be injected. The solution prepared for the control group will also contain 20 ml of 0.9% normal saline.

Hemoglobin level before Cesarean Section, Hemoglobin level after Cesarean Section, Blood transfusion

Type of randomization: simple Randomization unit: individual Randomization tool: envelop Random sequence generation: envelop shuffling Allocation concealment: central randomiation

After providing sufficient explanations and obtaining informed consent, the patients' initial data will be collected, and a distinct date for cesarean section will be determined. Participants will then be randomly assigned into intervention or control groups. For patients, ready-to-inject solutions are provided by the hospital pharmacy. The prepared solution for the intervention group is 20 ml in total, containing 1 ml of vasopressin, equivalent to 5 units, which is diluted in 19 ml of 0.9% normal saline. The solution prepared for the control group will also contain 20 ml of 0.9% normal saline. The only person who knows the contents of the solution is the pharmacist, and doctors do not know the contents of the syringes during the operation. After the intervention, the health care personnel will be also blinded.