The role of prophylactic internal iliac artery ligation in abnormally invasive placenta undergoing caesarean hysterectomy: a randomized control trial

J Matern Fetal Neonatal Med. 2019 Oct;32(20):3386-3392. doi: 10.1080/14767058.2018.1463986. Epub 2018 Apr 25.

Abstract

Objective: To identify the role of bilateral internal iliac artery (IIA) ligation on reducing blood loss in abnormally invasive placenta (AIP) undergoing caesarean hysterectomy. Methods: In this parallel-randomized control trial, 57 pregnant females with ultrasound features suggestive of AIP were enrolled. They were randomized into two groups; IIA group (n = 29 cases) performed bilateral IIA ligation followed by caesarean hysterectomies, while Control group (n = 28 cases) underwent caesarean hysterectomy only. The main outcome was the difference in the estimated intraoperative blood loss between the two groups. Results: There was no significant difference between the two groups regarding the intraoperative estimated blood loss (1632 ± 804 versus 1698 ± 1251, p value .83). The operative procedure duration (minutes) (223 ± 66 versus 171 ± 41.4, p value .001) varied significantly between the two groups. Conclusions: Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.

Keywords: Abnormally invasive placenta; adherent placenta; internal iliac artery ligation; placenta accreta; post-partum hemorrhage.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Balloon Occlusion
  • Blood Loss, Surgical / prevention & control*
  • Cesarean Section* / methods
  • Female
  • Humans
  • Hysterectomy* / methods
  • Iliac Artery / surgery*
  • Infant, Newborn
  • Ligation / methods
  • Placenta Accreta / surgery*
  • Placenta Previa / surgery*
  • Postpartum Hemorrhage / prevention & control
  • Pregnancy
  • Prophylactic Surgical Procedures / methods*
  • Treatment Outcome