Bilateral Internal Iliac Artery Ligation Before Cesarean Hysterectomy

Not Applicable

• Conditions: Placenta Accreta
• Interventions: Procedure: Cesarean hystrectomy; Procedure: Internal iliac artery ligation

• Registration Number: NCT03129035
• Lead Sponsor: Cairo University

Brief Summary

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

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 The ureter was retracted medially by gentle finger dissection, revealing the retroperitoneal anatomy.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.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Status Verified: 2017-04
• Study First Submitted: 2017-04-20
• Study First Submitted QC: 2017-04-25
• Last Update Submitted: 2017-04-25
• Study First Posted: 2017-04-26
• Last Update Posted: 2017-04-26
• Study Start: 2017-05
• Primary Completion: 2017-12
• Study Completion: 2018-02

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: Female
• Target Recruitment: 100

Inclusion Criteria

• women with suspected placenta accreta
• Scarred uterus
• Approving hysterectomy

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Exclusion Criteria

• Women needed conservative surgery
• women with coagulopathy or bleeding disorders

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
No internal iliac artery ligation	Cesarean hystrectomy	Women undergo cesarean hysterectomy after fetal extraction
internal iliac artery ligation	Cesarean hystrectomy	women undergo bilateral internal iliac artery ligation after fetal extraction and before proceeding in cesarean hysterectomy
internal iliac artery ligation	Internal iliac artery ligation	women undergo bilateral internal iliac artery ligation after fetal extraction and before proceeding in cesarean hysterectomy

Primary Outcome Measures

Name	Time	Method
Number of participants needed blood transfusion	within 24 hours from surgery	number of cases in each group who needed blood transfusion whether intraoperative or within 24 hours postoperative

Trial Locations

Locations (1)

Kasr Alainy medical school; 🇪🇬 Cairo, Egypt