الفهرس 
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Abstract
Postpartum haemorrhage (PPH) remains a major leading cause of direct maternal mortality. Placenta previa is considered one of the most common causes of postpartum hemorrhage. There are different modalities used to control PPH caused by placenta previa. Here we present cervical inversion as a new, easy-to-apply technique that is simple, rapid, and effective.
Our study provides short-term follow-up to cases who are managed by the cervical inversion technique, especially morphological cervical changes.
Our study was conducted among a total of 140 pregnant women over a period of one year from June 2021 to July 2022. The study was applied to two groups; the case group who were subjected to the cervical inversion technique and the control group who weren’t subjected to the cervical inversion technique and had attended to Minia University Maternity Hospital.
The Mean gestational age was significantly (p = 0.02) higher among patients in group two without cervical advancement (36.9±1.7) than those with (36.3±1.3), all patients with cervical advancement had a history of CS while all patients without cervical advancement had a history of NVD, and this difference was statistically significant (p = 0.0001). There were no significant differences between the two groups regarding age or the number of previous deliveries.
According to speculum examination, group1, 13 cases (19.7%) have slit -shaped external os, 5 cases (7.6%) have round shaped, 48 cases (72.7%) have pinpoint, and 66 cases (100%) have slit shaped in group 2.
Regarding position of the cervix in group 1, 20 cases (30.3%) have a central position; in 19 cases (28.8%) the cervix is taken up and easily accessible , but in 27 cases (40.9%) the cervix is taken up and difficult to access. In group 2, all cases have a central position of the cervix.
By sound examination of the cervix in group 1 with cervical advancement, 57 cases (86.4%) have easy entrance, but in 9 cases (13.6%) there is difficulty in the entrance of the sound through the cervix, but in group 2 without cervical advancement, all cases have easy entrance through the cervix with no difficulty .
Regarding fornices of the cervix in group 1, 19 (28.8%) cases have preserved fornices which can be felt and 47(71.2%) cases have partial or complete obliterated fornices , but in group 2, 66(100%) cases have preserved fornices which can be felt .
By hysterosalpingogram, in group 1, 65 cases (98.5%) are normal and only 1 case(1.5%) has an abnormal cervix , but in group 2, 66 cases (100%) are normal .
Regarding UADPI, in group 1, 56 cases (84.8%) are normal but 10 cases (15.2%) are abnormal, but in group 2, all cases (100%) are normal.
The mean cervical length in group 1 is 2.6±0.6 cm but in group 2 it is 2.8±0.5 cm, and the mean inner to inner diameter of the cervical canal in group 1 is 0.7±0.8 cm but in group 2 it is 1.4±0.08 cm .
Regarding the complications recorded in our study in group 1 who were managed by cervical advancement technique ; 3 cases (4.5%) have wound infection , 3 cases (4.5%) have secondary post-partum hemorrhage, 6 cases (9.09%) have bladder injury, 1 case (1.5%) has ureteric ligation, and 5 cases (7.6%) have hematometra, but in group 2 there is no complication in 56 (84.8%) cases, 1 case (1.5%) has wound infection, 6 cases (9.1%) have secondary post-partum hemorrhage, and 3 cases (4.5%) have bladder injury.
The conclusion that may be drawn from this study is that The currently evaluated technique of using the cervix as a natural tamponade to control intrapartum and postpartum haemorrhage caused by placenta accreta is apparently safe and effective. Cervical advancement doesn’t affect the cervix negatively, as the cervix is in normal morphology and normal position, and there isn’t any marked shortness of cervix or widening of the cervical canal. Further studies are needed with extended follow-up of the technique using Electro Utero Graph and histopathological correlation.