Placenta Accreta
Conditions
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 The ureter was retracted medially by gentle finger dissection, revealing the retroperitoneal anatomy.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.
Interventions
PROCEDURECesarean hystrectomy
Upper segment cesarean section followed by fetal extraction and cesarean hystrectomy started without any attempts of placental removal
PROCEDUREInternal iliac artery ligation
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 The ureter was retracted medially by gentle finger dissection, revealing the retroperitoneal anatomy.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
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
20 Years to 44 Years
Healthy volunteers
No
Inclusion criteria
* women with suspected placenta accreta * Scarred uterus * Approving hysterectomy
Exclusion criteria
* Women needed conservative surgery * women with coagulopathy or bleeding disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 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 |
Countries
Egypt
Contacts
Primary ContactAhmed Maged, MD
Outcome results
None listed