Role of Ligation of the Anterior Division of the Internal Iliac Artery in Conservative Management of Patients Diagnosed With Partial or Focal Placenta Accreta Spectrum
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Placenta Accreta
- Sponsor
- Cairo University
- Enrollment
- 44
- Locations
- 1
- Primary Endpoint
- Amount of blood loss 24 hours post-operative
- Status
- Completed
- Last Updated
- 9 months ago
Overview
Brief Summary
The patients will be divided into 2 groups:
Group (A) - Study group: Cases managed by lower segment resection with ligation of the anterior division of the internal iliac artery
Group (B) - Control group: Cases managed by lower segment resection without ligation of the anterior division of the internal iliac artery
The following operative details will be recorded:
- Estimation of total blood loss
- Pre and 24-h post-operative hemoglobin (g/dl).
- The need for blood transfusion and its amount intra or postoperative will be recorded
- Operative time and postoperative hospital stay will be recorded.
- Close post-operative monitoring of the patients' vital signs, drain output, and urine output
- Presence or absence of intraoperative complications; bladder, ureteric, bowel, or vascular injuries will be recorded.
- Monitoring for postoperative morbidities
Detailed Description
The patients will be divided into 2 groups: Group (A) - Study group: Cases managed by uterine lower segment resection with ligation of the anterior division of the internal iliac artery (4 cm distal to the bifurcation of the common iliac artery). Group (B) - Control group: Cases managed by uterine lower segment resection without ligation of the anterior division of the internal iliac artery. In both groups, bilateral uterine artery ligation at 2 levels will be done; bilateral ligation at a level below the lower most placental part, followed by bilateral uterine artery ligation at the level of the hysterotomy incision. The following operative details will be recorded: * Estimation of total blood loss * Pre and 24-h post-operative hemoglobin (g/dl). * The need for blood transfusion and its amount intra or post-operative will be recorded * Operative time and postoperative hospital stay will be recorded. * Close post-operative monitoring of the patients' vital signs, drain output, and urine output * Presence or absence of intraoperative complications; bladder, ureteric, bowel, or vascular injuries will be recorded. * Monitoring for postoperative morbidities
Investigators
Abdalla Mousa
Principal Investigator
Cairo University
Eligibility Criteria
Inclusion Criteria
- •Age: 20-40 years old.
- •Pregnancy of singleton living fetus.
- •Previous one or more cesarean sections.
- •Gestational age: \> 36 weeks.
- •Elective termination of pregnancy.
- •Cases not requiring preoperative blood transfusion.
- •Cases with focal area of placental adherence or invasion leaving sufficient healthy myometrial tissue for uterine repair and preservation.
- •The following ultrasound markers such as "loss of clear retroplacental translucency", "myometrial thinning", "abnormal lacunae", "irregular bladder wall", "utero-vesical hypervascularity".
Exclusion Criteria
- •Multifetal pregnancy.
- •More than four previous sections.
- •Emergency termination of pregnancy due to antepartum hemorrhage, placental separation or rupture uterus.
- •Intrauterine fetal death.
- •Women with history of any medical disorder with pregnancy eg. Gestational diabetes and hypertension.
- •Premature rupture of membranes.
- •Cases misdiagnosed as placenta accreta by ultrasound preoperatively, and spontaneous full placental separation occurred intraoperative. "will be excluded before randomization"
- •Cases with PAS with total invasion involving all placental lobules.
- •Cases who will be managed by cesarean hysterectomy due to uncontrolled intraoperative bleeding.
Outcomes
Primary Outcomes
Amount of blood loss 24 hours post-operative
Time Frame: 24 hours post-operative
Amount of blood loss 24 hours post-operative
Amount of blood loss intra-operative
Time Frame: during operation
Amount of blood loss intra-operative
Secondary Outcomes
- Operative time(during operation)
- Number of blood units transfused(within 24 hours after surgery)