Intraoperative internal iliac artery balloon occlusion versus ligation in cases of placenta previa accreta: A randomized trial

Aims: The aim of the study was to compare the efficacy of intraoperative bilateral internal iliac artery balloon occlusion versus bilateral internal iliac artery ligation before extraction of placenta previa accreta after fetal delivery. Methods: One hundred patients with preoperative diagnosis of placenta previa accreta were randomly allocated into two groups each including 50 patients; Group (A) intraoperative internal iliac artery (IIA) balloon occlusion was undergone and Group (B) internal iliac artery ligation was undergone. Then delivery of the fetus and the placenta was removed in a piecemeal manner; any remaining placental bed bleeding was controlled by different surgical techniques. Statistical analysis: The collected data were computerized and statistically analyzed using SPSS program (Statistical Package for Social Science) version 20. Qualitative data were represented as frequencies and relative percentages and quantitative data were expressed as mean±SD (Standard deviation). We used two statistical tests for detection of the difference between the two studied groups: The student “t” test for comparison of means of quantitative variables of Mohamed Lotfy Mohamed El-sayed1, Ahmed Mohamed Elhuseiny1, Mostafa Abdo Ahmed1, Sameh Saber2 Affiliations: 1Department of Obstetrics and Gynecology, Faculty of medicine, Zagazig University, Egypt; 2Department of Radiodiagnosis, Faculty of medicine, Zagazig University, Egypt. Corresponding Author: Mohamed Lotfy Mohamed El-sayed, Assistant professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Faculty of medicine, Zagazig University; E-mail: drmohamedlotfy@yahoo.com Received: 14 May 2016 Accepted: 16 August 2016 Published: 16 September 2016 two independent groups and chi-square test was used to calculate difference between qualitative variables and find the association between row and column variables. Both tests are used for normally distributed data. Results: Satisfactory hemostasis was achieved in 33 patients (33/50 = 66%) in IIA balloon occlusion group while hemostasis was achieved in 29 patients (29/50 = 58%) in IIA ligation group, whereas additional surgical interference were performed in (12/50 = 24%) and (15/50 = 30%) of IIA balloon occlusion group and IIA ligation group respectively. Emergent hysterectomy was performed in (5/50=10%) of IIA occlusion group and (6/50 = 12%) of IIA ligation group. Blood transfusion during operation in 36 patients (36/50 = 72%) and three patients on the first 24 hours after the operation while in IIA ligation group blood transfusion during operation in 39 patients (39/50 = 78%) and five patients on the first 24 hour after the operation. The postoperative hospital stay was shorter with IIA occlusion group. Conclusion: Placenta accreta is a potentially lifethreatening condition that carries a high rate of maternal morbidity and mortality. Bilateral internal iliac arteries occlusion before extraction of the placenta seemed to be an effective and safe technique to decrease intrapartum and postpartum complications, and to minimize the risk of the emergent hysterectomy.