The perioperative maternal outcomes of bilateral internal iliac artery ligation in morbidly adherent placenta previa

• Main Authors: Ayman Abd-Elhakim Abd-Elghany, Nasser T Elshamy, Ibrahim Shalaby
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Journal of Medicine in Scientific Research
• Subjects: internal iliac artery; morbidly adherent placenta; placenta previa; surgical fertility preservation
• Online Access: http://www.jmsr.eg.net/article.asp?issn=2537-091X;year=2018;volume=1;issue=4;spage=292;epage=298;aulast=Abd-Elghany
• ISSN: 2537-091X; 2537-0928

Objective The aim was to detect the effects of bilateral internal iliac artery ligation (IIAL) either before or after placental separation on the intraoperative and postoperative maternal outcomes. Background Morbidly adherent placenta (MAP) is abnormal adherence of the placenta to the underlying uterine wall. It can cause significant adverse maternal consequences including the risk of severe intrapartum and/or postpartum bleeding, cesarean hysterectomy, intensive care unit admission, and prolonged hospitalization days. Early diagnosis of MAP helps optimal management with decrease of maternal and neonatal compromise. Uterine sparing can be attempted for patients seeking for fertility preservation. For those patients, several surgical hemostatic techniques including the prophylactic IIAL seemed to reduce blood supply to the pelvic organs and consequently, prevent life-threatening intraoperative blood loss and reduce transfusion requirements. Participants and methods The research is a randomized clinical trial that was conducted on 30 inpatient pregnant women – with inclusion and exclusion criteria – diagnosed by ultrasound to have placenta previa with MAP. The study population is divided into test and control groups according to the intervention of bilateral IIAL. The primary operative outcome was the direct blood loss assessment, the secondary outcomes were the indirect measures of blood loss (shock index, hemoglobin and hematocrite concentrations, and blood transfusion units), and the tertiary outcomes were the maternal mortality and morbidities and the operative and postoperative time variables. Results The prophylactic IIAL (group 1) significantly decreased the intraoperative time by approximately 48 min, the bleeding control time by 47%, operative blood loss by 40%, the number of transfusion units of packed red blood cells, and the shock index (a mean of 1.12). There were marked significant blood hemoglobin and hematocrit differences, with the highest mean in group 1 (8.66 g/dl and 28.3%, respectively). The postoperative results revealed decrease in the hospital stay time and the febrile period in prophylactic IIAL, with means difference of −1.7 and −2 days, respectively. The frequencies of emergency hysterectomy (2/30 cases), urinary tract injuries (1/30 case), and maternal mortality (1/30 case) were absolutely confined to the group without the intervention of IIAL (group B). Conclusion In placenta previa with MAP, the operative bilateral IAAL either before or after placental separation – but the superiority for prophylactic IAAL – decreased intrapartum and postpartum complications and minimized the risk of the emergent hysterectomy.