Bilateral Internal Iliac Artery Ligation Before Cesarean Hysterectomy

Cairo University (CU)

Status: Unknown

Conditions: Placenta Accreta

Treatments: Procedure: Internal iliac artery ligation; Procedure: Cesarean hystrectomy

Study type: Interventional

Funder types: Other

Identifiers

NCT03129035

4

Details and patient eligibility

About

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

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 The ureter was retracted medially by gentle finger dissection, revealing the retroperitoneal anatomy.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

Enrollment: 100 estimated patients

Sex: Female

Ages: 20 to 44 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

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

Exclusion criteria

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

100 participants in 2 patient groups

internal iliac artery ligation

Active Comparator group

Description:

women undergo bilateral internal iliac artery ligation after fetal extraction and before proceeding in cesarean hysterectomy

Treatment:

Procedure: Cesarean hystrectomy

Procedure: Internal iliac artery ligation

No internal iliac artery ligation

Active Comparator group

Description:

Women undergo cesarean hysterectomy after fetal extraction

Treatment:

Procedure: Cesarean hystrectomy