Key result
Bilateral internal iliac artery ligation during conservative management of morbidly adherent placenta significantly increased blood loss, transfusions, and hysterectomy rates compared to no ligation.
Why the study?
Hysterectomy for placenta accreta precludes future fertility, while internal iliac artery ligation has restricted effectiveness in controlling hemorrhage during conservative uterine-preserving management.
Does bilateral internal iliac artery ligation reduce blood loss and hysterectomy rates in patients with placenta previa undergoing conservative management of morbidly adherent placenta?
RCT (n=42)
Does bilateral internal iliac artery ligation reduce blood loss and hysterectomy rates in patients with placenta previa undergoing conservative management of morbidly adherent placenta?
Bilateral internal iliac artery ligation does not reduce, and may actually increase, blood loss and hysterectomy rates during conservative management of morbidly adherent placenta.
Bilateral internal iliac artery ligation should be avoided in conservative management; challenges presumed benefit and supports no-ligation approach for morbidly adherent placenta.
Background: Placenta accreta is becoming a common complication of pregnancy. Hysterectomy has been considered the best therapeutic modality in the context of it, but this represents a problem for patients desiring to preserve the uterus for future fertility. Surgical internal iliac artery ligation (IIAL) is usually utilized to attempt to control obstetric hemorrhage. Ligation of the internal iliac arteries has restricted effectiveness. Either ligation of the anterior division of the internal iliac or uterine artery is often employed in a trial to control postpartum hemorrhage (PPH) before resorting to hysterectomy. Objective: To assess the efficacy of IIAL before bladder dissection during conservative management of cases of the morbidly adherent placenta (MAP) using a cervico-isthmic compression suture. Patients and methods: This randomized control study comprised 42 patients with placenta previa (major and minor); divided into two groups; group A (21 patients with bilateral ligation of IIA) and group B (21 patients without ligation of IIA). Results: The amount of blood loss in group A was more than in group B. There was a statistically significantly higher number of packed RBCs transfused units, total estimated blood loss (liters) in group A vs group B. The rate of hysterectomy was statistically higher among group A than Group B. Conclusion: This study demonstrated that bilateral IIAL, as an intervention to reduce blood loss during conservative management for AIP using cervico-isthmic compression suture (CIC), is not beneficial.
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Rizk et al. (2022) conducted an RCT in Placenta accreta spectrum / morbidly adherent placenta (n=42). Bilateral internal iliac artery ligation (IIAL) vs. No ligation of IIA was evaluated on Blood loss, packed RBCs transfused, and rate of hysterectomy. Bilateral internal iliac artery ligation during conservative management of morbidly adherent placenta significantly increased blood loss, transfusions, and hysterectomy rates compared to no ligation.
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