Internal Iliac Artery Ligation During Management of Placenta Accreta Spectrum
Condition: Placenta Accreta
MeSH terms: Placenta Accreta
Study type: Interventional

Summary: 
      Vessels ligation have been used as a part of conservative management in treatment of placenta
      accrete spectrum to decrease blood loss as uterine artery ligation and internal iliac artery
      ligation. Surgical ligation of the anterior divisions of the internal iliac artery is
      practiced by many tertiary care centers during management of women with PAS disorders.
      However there is no recommendation toward the routine use of internal iliac artery ligation
      before bladder dissection during conservative management of (placenta accrete spectrum). The
      retroperitoneal space will be dissected and bifurcation of common iliac vessels will be
      identified, After identifying the ureter, the internal iliac artery will be dissected on both
      sides away from surrounding tissues and from adjacent iliac vein. The anterior branch of each
      internal iliac artery will be then prophylactically ligated using suture ligation
      approximately 2-3 cm distal to common iliac artery bifurcation in order to avoid ligation of
      the posterior division. Principal investigators will conduct a study to evaluate the efficacy
      of internal iliac artery ligation before bladder dissection during conservative management
      using cervico isthmic compression suture in cases of Placenta accrete spectrum.
    

Detailed description: 
      Surgical technique for all participants will be (Cervico isthmic compression suture)

      Steps:

        -  Abdominal wall Incision will be done either in the midline or transverse suprapubic
           incision.

        -  Opening the abdominal wall in layers.

        -  Uterine incision will be done at the upper border of the placenta determined at
           laparotomy by naked eye.

        -  Delivery of the baby. Then the placenta will be left in place till doing
           devascularisation and bladder dissection

        -  Participants then will be, divided into two groups Participants in internal iliac group
           will undergo internal iliac artery ligation before bladder dissection Participants in no
           internal iliac artery group will undergo bladder dissection immediately without internal
           iliac artery ligation
    

Intervention name(s): Internal iliac artery ligation with cervicoisthmic compression suture; Cervicoisthmic compression suture without Internal iliac artery ligation
Intervention type(s): Procedure; Procedure
Intervention description(s): Retroperitoneal approach will be performed to ligate both internal iliac arteries before bladder dissection followed by cervicoisthmic compression suture application at placental bed; Bladder dissection followed by cervicoisthmic compression suture application at placental bed without Internal iliac artery ligation
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized controlled trial.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: placenta accrete spectrum