Is there a role of prophylactic bilateral internal iliac  artery ligation on reducing the bleeding during  cesarean hysterectomy in patients with placenta  percreta? A retrospective cohort study

Sucu, Seyhun; Özcan, Hüseyin Çağlayan; Karuserci, Özge Kömürcü; Demiroğlu, Çağdaş; Tepe, Neslihan Bayramoğlu; Bademkıran, Muhammed Hanifi

doi:10.5603/gp.a2020.0145

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…For this reason, it is recommended that the surgical procedures planned to be applied to the patients should be evaluated carefully and on a case-by-case basis preoperatively [14]. In recent years, the number of studies involving crucial surgical techniques such as internal iliac artery ligation or embolization [15,16] on reducing the amount of perioperative bleeding in PAS patients with severe placental invasion has remarkably increased due to the issue's vital importance. Severe placental invasion in PAS patients is one of the most important causes of intraoperative hemorrhages [17,18].…”

Section: Discussionmentioning

confidence: 99%

The potential role of preoperative cystoscopy for determining the depth of invasion in the placenta accreta spectrum

et al. 2023

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Objectives: This study aims to determine the role of preoperative cystoscopy in specifying the degree of placental invasion to the bladder in the placenta accreta spectrum (PAS), especially in percreta. Material and methods:This prospective observational cohort study included 78 PAS patients. All included patients underwent the preoperative cystoscopy before the cesarean hysterectomy operation. The preoperative cystoscopy procedure identified markers of PAS as neovascularization, arterial pulsatility in neovascularized zones, and posterior bladder wall bulging. Then the patients were divided into subgroups according to the histopathological results of their cesarean hysterectomy specimens. Finally, the histopathological subgroups of PAS were estimated using preoperative cystoscopy signs in the designed logistic regression analysis model. Results:The preoperative cystoscopic signs such as neovascularization, the posterior bladder wall bulging, and the arterial pulsatility in neovascularized zones were approximately associated with a 17-fold [OR = 16.9 (95% CI, 5.7-49.8)], 26-fold [OR = 26.1 (95% CI, 8.17-83.8)], and 9-fold [OR = 8.94 (95% CI, 2.94-27.1)] increase in the likelihood of placenta percreta, respectively. Conclusions:Preoperative cystoscopy may significantly contributions to other standard imaging modalities to identify the degree of placental invasion, especially placenta percreta. Experienced obstetricians trained in hysteroscopic visualization may safely perform this preoperative cystoscopy procedure under the guidance of a specialist urologist. Accordingly, it may be possible to estimate the degree of invasion and the course of surgery in patients with PAS using the preoperative cystoscopy procedure.

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Section: Discussionmentioning

confidence: 99%

The potential role of preoperative cystoscopy for determining the depth of invasion in the placenta accreta spectrum

et al. 2023

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“…[9] Prophylactic balloon occlusion of the iliac arteries is an interventional procedure, and its effectiveness in controlling blood loss in placenta accreta remains controversial. [9,10] Balloon occlusion of IIAs is widely performed in high-resource settings to reduce intraoperative blood loss in patients with AIP. However, serious complications may occur, including IIA thrombosis, acute lower extremity ischemia, arterial pseudoaneurysms, arterial rupture.…”

Section: Discussionmentioning

confidence: 99%

Treatment of infected placenta accreta in the uterine horn by transabdominal temporary occlusion of internal iliac arteries: A case report and literature review

Liu

Ren

et al. 2023

Medicine

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Rationale: This case report aims to describe the treatment of infected placenta accreta in the uterine horn by transabdominal temporary occlusion of internal iliac arteries. Patient concerns: A 29-year-old female patient had a history of retained placenta for 28 days after labor induction in the second trimester of pregnancy because of fetal malformation. Diagnoses: Placenta accreta in the uterine horn was diagnosed by 3-dimensional ultrasound and magnetic resonance imaging, and the diagnosis was confirmed during the operation. Interventions: Laparotomy was performed to remove the placenta and repair the uterine defect after temporary occlusion of both internal iliac arteries. Outcomes: Body temperature and inflammatory markers were elevated at admission but returned to normal on the second day after surgery. Normal menstruation resumed approximately 1 month postoperatively. Ultrasound examination showed that the shape of the uterine cavity was normal. No postoperative complications were observed. Lessons: Temporary occlusion of the internal iliac artery can help effectively manage infected placenta accreta in the uterine horn.

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“…A summary of the quality assessment for the included randomized trials (22,23) is shown in Supplementary appendix 1. Six cohort studies (24)(25)(26)(27)(28) were fair in quality according to NIH quality assessment tool for Observational Cohort and Cross-Sectional Studies. The other four cohort studies (16,(29)(30)(31) and were of poor quality.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Therapeutic effect of Internal iliac artery ligation and uterine artery ligation techniques for bleeding control in placenta accreta spectrum patients: A meta-analysis of 795 patients

et al. 2022

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Placenta accreta spectrum (PAS) can cause complications like hysterectomy or death due to massive pelvic bleeding. We aim to evaluate the efficacy of two different arterial ligation techniques in controlling postpartum haemorrhage and minimizing bleeding complications. We searched six databases. 11 studies were finally included into our review and analysis. We graded their quality using the Cochrane tool for randomized trials and the NIH tool for retrospective studies. Our analysis showed that internal iliac artery ligation has no significant effect on bleeding control (MD = −248.60 [−1045.55, 548.35] P = 0.54), while uterine artery ligation significantly reduced the amount of blood loss and preserved the uterus (MD = −260.75, 95% CI [−333.64, −187.86], P < 0.00001). Uterine artery ligation also minimized the need for blood transfusion. Bleeding was best controlled by combining both uterine artery ligation with uterine tamponade (MD = 1694.06 [1675.34, 1712.78], P < 0.00001). This combination also showed a significant decrease in hysterectomy compared to the uterine artery ligation technique alone. Bilateral uterine artery ligation in women with placenta accreta spectrum can effectively reduce the amount of bleeding and the risk of complications. The best bleeding control tested is a combination of both, uterine artery ligation and cervical tamponade. These techniques may offer an easy and applicable way to preserve fertility in PAS patients. Larger randomized trials are needed to define the best technique.

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Is there a role of prophylactic bilateral internal iliac artery ligation on reducing the bleeding during cesarean hysterectomy in patients with placenta percreta? A retrospective cohort study

Cited by 5 publications

References 27 publications

The potential role of preoperative cystoscopy for determining the depth of invasion in the placenta accreta spectrum

The potential role of preoperative cystoscopy for determining the depth of invasion in the placenta accreta spectrum

Treatment of infected placenta accreta in the uterine horn by transabdominal temporary occlusion of internal iliac arteries: A case report and literature review

Therapeutic effect of Internal iliac artery ligation and uterine artery ligation techniques for bleeding control in placenta accreta spectrum patients: A meta-analysis of 795 patients

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