NCT04593303

Internal Iliac Artery Ligation During Management of Placenta Accreta Spectrum

Validity of Internal Iliac Artery Ligation With Cervico Isthmic Compression Suture During Conservative Management of Placenta Accreta Spectrum

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 42 (actual)
• Sponsor: Mansoura University Hospital · Academic / Other
• Sex: Female
• Age: 18 Years – 35 Years
• Healthy volunteers: Not accepted

Summary

Vessels ligation have been used as a part of conservative management in treatment of placenta accrete spectrum to decrease blood loss as uterine artery ligation and internal iliac artery ligation. Surgical ligation of the anterior divisions of the internal iliac artery is practiced by many tertiary care centers during management of women with PAS disorders. However there is no recommendation toward the routine use of internal iliac artery ligation before bladder dissection during conservative management of (placenta accrete spectrum). The retroperitoneal space will be dissected and bifurcation of common iliac vessels will be identified, After identifying the ureter, the internal iliac artery will be dissected on both sides away from surrounding tissues and from adjacent iliac vein. The anterior branch of each internal iliac artery will be then prophylactically ligated using suture ligation approximately 2-3 cm distal to common iliac artery bifurcation in order to avoid ligation of the posterior division. Principal investigators will conduct a study to evaluate the efficacy of internal iliac artery ligation before bladder dissection during conservative management using cervico isthmic compression suture in cases of Placenta accrete spectrum.

Detailed description

Surgical technique for all participants will be (Cervico isthmic compression suture) Steps: * Abdominal wall Incision will be done either in the midline or transverse suprapubic incision. * Opening the abdominal wall in layers. * Uterine incision will be done at the upper border of the placenta determined at laparotomy by naked eye. * Delivery of the baby. Then the placenta will be left in place till doing devascularisation and bladder dissection * Participants then will be, divided into two groups Participants in internal iliac group will undergo internal iliac artery ligation before bladder dissection Participants in no internal iliac artery group will undergo bladder dissection immediately without internal iliac artery ligation

Conditions

• Placenta Accreta

Interventions

Type	Name	Description
PROCEDURE	Internal iliac artery ligation with cervicoisthmic compression suture	Retroperitoneal approach will be performed to ligate both internal iliac arteries before bladder dissection followed by cervicoisthmic compression suture application at placental bed
PROCEDURE	Cervicoisthmic compression suture without Internal iliac artery ligation	Bladder dissection followed by cervicoisthmic compression suture application at placental bed without Internal iliac artery ligation

Timeline

• Start date: 2020-09-01
• Primary completion: 2022-01-01
• Completion: 2022-01-01
• First posted: 2020-10-19
• Last updated: 2022-04-06

Locations

1 site across 1 country: Egypt