Prophylactic bilateral internal iliac artery ligation for management of low-lying placenta accreta: a prospective study

Abstract

Background Morbidly adherent placenta is one of the most feared complications causing high morbidity and mortality in obstetrics. Cesarean hysterectomy is still the main procedure in the current management of patients diagnosed with morbidly adherent placenta. Objective To evaluate the efficacy of prophylactic bilateral hypogastric arteries ligation on maternal outcome in diagnosed cases of morbidly adherent placenta. Design Prospective study. Setting Obstetrics and Gynecology Department, Mansoura University Hospital, Egypt. Methods This was a prospective cohort study of 51 pregnant women with a history of previous cesarean sections and diagnosed with low-lying abnormally adherent placenta. All patients underwent prophylactic internal iliac artery ligation after fetal delivery and before extraction of the placenta, the placenta was removed manually in a piecemeal manner and any remaining bleeding points from the placental site were then controlled by hemostatic sutures. Results Bilateral internal iliac artery ligation was performed in patients with invasive placenta (accreta and increta) (46/51 = 90.1%) and satisfactory hemostasis was achieved in 38 patients (38/46 = 82.6%). In five patients with placenta previa increta (5/17 = 29.4%), there was uncontrolled blood loss; thus, we proceeded to cesarean hysterectomy. The mean intraoperative blood loss was 1255 ± 589 ml. Blood transfusion was necessary in 35 patients (35/46 = 76%) during the operations. The mean hemoglobin and hematocrit 1 day after the operation were 9.8 ± 1.3 and 31.4 ± 2.3, respectively. Conclusion Prophylactic bilateral internal iliac artery ligation before extraction of placenta accrete seemed to be an effective technique to decrease cesarean complications and avoid emergent peripartum hysterectomy.