Bilateral Internal Iliac Artery Ligation Before Cesarean Hysterectomy

Study Overview
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Brief Summary
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All women with placenta accreta will be managed by upper segment cesarean section followed by cesarean hysterectomy without attempts of placental removal. Women were randomized to either bilateral internal iliac artery ligation before hysterectomy and after fetal extraction or no additional intervention

Detailed Description
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All women with placenta accreta will be managed by upper segment cesarean section followed by cesarean hysterectomy without attempts of placental removal. Women were randomized to either bilateral internal iliac artery ligation before hysterectomy and after fetal extraction or no additional intervention. Midline incision in the all patients is preferred. The retroperitoneal space was entered at the level of common iliac bifurcation and followed to the point of division into the external and internal iliac arteries. The ureter was retracted medially by gentle finger dissection, revealing the retroperitoneal anatomy. The fat and loose connective tissue around the IIA and vein were removed and a right-angle clamp was passed beneath the IIA from the lateral to the medial side approximately 4 cm distal to its origin. Using an absorbable suture, the IIA was ligated doubly in all cases . Pulsations of the external iliac and femoral arteries were identified after internal iliac ligation. The procedure was then repeated on the other side.

Official Title
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Bilateral Internal Iliac Artery Ligation Before Cesarean Hysterectomy : A Randomized Controlled Trial

Conditions
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Placenta Accreta

Intervention / Treatment
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* Procedure: Cesarean hystrectomy
* Procedure: Internal iliac artery ligation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: women with suspected placenta accreta Scarred uterus Approving hysterectomy Exclusion Criteria: Women needed conservative surgery women with coagulopathy or bleeding disorders

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 44 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: internal iliac artery ligation<br>women undergo bilateral internal iliac artery ligation after fetal extraction and before proceeding in cesarean hysterectomy | Procedure: Cesarean hystrectomy<br>* Upper segment cesarean section followed by fetal extraction and cesarean hystrectomy started without any attempts of placental removal<br>Procedure: Internal iliac artery ligation<br>* The retroperitoneal space was entered at the level of common iliac bifurcation and followed to the point of division into the external and internal iliac arteries. The ureter was retracted medially by gentle finger dissection, revealing the retroperitoneal anatomy. The fat and loose connective tissue around the IIA and vein were removed and a right-angle clamp was passed beneath the IIA from the lateral to the medial side approximately 4 cm distal to its origin. Using an absorbable suture, the IIA was ligated doubly in all cases . Pulsations of the external iliac and femoral arteries were identified after internal iliac ligation. The procedure was then repeated on the other side<br>|
| Active Comparator: No internal iliac artery ligation<br>Women undergo cesarean hysterectomy after fetal extraction | Procedure: Cesarean hystrectomy<br>* Upper segment cesarean section followed by fetal extraction and cesarean hystrectomy started without any attempts of placental removal<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants needed blood transfusion | number of cases in each group who needed blood transfusion whether intraoperative or within 24 hours postoperative | within 24 hours from surgery |