الفهرس 
Aim of the Work
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Abstract
The aim of the study was to audit the surgical approach to patients with placenta previa/accreta. Direct observation of all cases undergoing cesarean section for placenta previa at WHH in the period between July 2014 to July 2015. Ninety eight cases were included
Patients demographic and clinical data were taken and recorded. Demographic data included age, parity, education, occupation and duration of marriage . Clinical data included gravidity, parity, number of previous cesarean section, past history of any intrauterine maneuver that can cause trauma to the endometrium . Data also included onset , duration of hemorrhage, amount, recurrence or frequency, the fundal height, presentation and position of the fetus. Also status of fetal wellbeing was recorded. The last Hemoglobin and hematocrit value as well as the coagulation profile were also recorded
A specially designed proforma was used for observation by the investigator team. The proforma is an adaptation of the auditable standards in the RCOG guideline (Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management January 2011). The proforma was filled by direct observation.
In 71.4 %, the cesarean was done as an emergency. Consultant anesthesia presence was documented in 13.1% and consultant obstetrician attended 28% of these cesarean sections. In all cases, a low transverse skin incision was used and in 91%, a lower segment transverse uterine incision. The placenta was avoided only in 61.2 %. Balloon tamponade using Bakri Balloon was done in 12 cases, compression sutures were used in 34 %, uterine artery ligation was done in 91% and hysterectomy was done in 16.3%.