Ligation of Anterior Internal Iliac Artery With Conservative Management of Partial or Focal Placenta Accreta Spectrum

Phase

N/A

Condition

N/A

Treatment

Control group: lower segment resection without ligation of the anterior division of the internal iliac artery

Study group: lower segment resection with ligation of the anterior division of the internal iliac artery

Clinical Study ID

NCT05471102

MS-38-2022

Ages 20-40
Female
Accepts Healthy Volunteers

Study 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

Eligibility Criteria

Inclusion

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 healthymyometrial tissue for uterine repair and preservation.
The following ultrasound markers such as "loss of clear retroplacentaltranslucency", "myometrial thinning", "abnormal lacunae", "irregular bladder wall", "utero-vesical hypervascularity".

Exclusion

Exclusion Criteria:

Multifetal pregnancy.
More than four previous sections.
Emergency termination of pregnancy due to antepartum hemorrhage, placentalseparation or rupture uterus.
Intrauterine fetal death.
Women with history of any medical disorder with pregnancy eg. Gestational diabetesand hypertension.
Premature rupture of membranes.
Cases misdiagnosed as placenta accreta by ultrasound preoperatively, and spontaneousfull placental separation occurred intraoperative. "will be excluded beforerandomization"
Cases with PAS with total invasion involving all placental lobules.
Cases who will be managed by cesarean hysterectomy due to uncontrolledintraoperative bleeding.

Study Design

Control group: lower segment resection without ligation of the anterior division of the internal iliac artery

July 03, 2022

January 31, 2024

Study 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.