Ligation of Anterior Internal Iliac Artery With Conservative Management of Partial or Focal Placenta Accreta Spectrum

Role of Ligation of the Anterior Division of the Internal Iliac Artery in Conservative Management of Patients Diagnosed With Partial or Focal Placenta Accreta Spectrum

The patients will be divided into 2 groups:

Group (A) - Study group: Cases managed by lower segment resection with ligation of the anterior division of the internal iliac artery

Group (B) - Control group: Cases managed by lower segment resection without ligation of the anterior division of the internal iliac artery

The following operative details will be recorded:

• Estimation of total blood loss
• Pre and 24-h post-operative hemoglobin (g/dl).
• The need for blood transfusion and its amount intra or postoperative will be recorded
• Operative time and postoperative hospital stay will be recorded.
• Close post-operative monitoring of the patients' vital signs, drain output, and urine output
• Presence or absence of intraoperative complications; bladder, ureteric, bowel, or vascular injuries will be recorded.
• Monitoring for postoperative morbidities

Study Overview

• Status: Completed
• Conditions: Placenta Accreta
• Intervention / Treatment: Procedure: Study group: lower segment resection with ligation of the anterior division of the internal iliac artery; Procedure: Control group: lower segment resection without ligation of the anterior division of the internal iliac artery

Detailed Description

The patients will be divided into 2 groups:

Group (A) - Study group: Cases managed by uterine lower segment resection with ligation of the anterior division of the internal iliac artery (4 cm distal to the bifurcation of the common iliac artery).

Group (B) - Control group: Cases managed by uterine lower segment resection without ligation of the anterior division of the internal iliac artery.

In both groups, bilateral uterine artery ligation at 2 levels will be done; bilateral ligation at a level below the lower most placental part, followed by bilateral uterine artery ligation at the level of the hysterotomy incision.

The following operative details will be recorded:

• Estimation of total blood loss
• Pre and 24-h post-operative hemoglobin (g/dl).
• The need for blood transfusion and its amount intra or post-operative will be recorded
• Operative time and postoperative hospital stay will be recorded.
• Close post-operative monitoring of the patients' vital signs, drain output, and urine output
• Presence or absence of intraoperative complications; bladder, ureteric, bowel, or vascular injuries will be recorded.
• Monitoring for postoperative morbidities

• Study Type: Interventional
• Enrollment (Actual): 44
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt
    • Cairo University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 40 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age: 20-40 years old.
• Pregnancy of singleton living fetus.
• Previous one or more cesarean sections.
• Gestational age: > 36 weeks.
• Elective termination of pregnancy.
• Cases not requiring preoperative blood transfusion.
• Cases with focal area of placental adherence or invasion leaving sufficient healthy myometrial tissue for uterine repair and preservation.
• The following ultrasound markers such as "loss of clear retroplacental translucency", "myometrial thinning", "abnormal lacunae", "irregular bladder wall", "utero-vesical hypervascularity".

Exclusion Criteria:

• Multifetal pregnancy.
• More than four previous sections.
• Emergency termination of pregnancy due to antepartum hemorrhage, placental separation or rupture uterus.
• Intrauterine fetal death.
• Women with history of any medical disorder with pregnancy eg. Gestational diabetes and hypertension.
• Premature rupture of membranes.
• Cases misdiagnosed as placenta accreta by ultrasound preoperatively, and spontaneous full placental separation occurred intraoperative. "will be excluded before randomization"
• Cases with PAS with total invasion involving all placental lobules.
• Cases who will be managed by cesarean hysterectomy due to uncontrolled intraoperative bleeding.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Study group; Cases managed by uterine lower segment resection with ligation ((suturing)) of the anterior division of the internal iliac artery (4 cm distal to the bifurcation of the common iliac artery); in addition to the bilateral uterine artery ligation at 2 levels; bilateral ligation at a level below the lower most placental part followed by bilateral uterine artery ligation at the level of the hysterotomy incision.	Procedure: Study group: lower segment resection with ligation of the anterior division of the internal iliac artery; Cases managed by uterine lower segment resection with ligation ((suturing)) of the anterior division of the internal iliac artery (4 cm distal to the bifurcation of the common iliac artery); in addition to the bilateral uterine artery ligation at 2 levels; bilateral ligation at a level below the lower most placental part followed by bilateral uterine artery ligation at the level of the hysterotomy incision.
Placebo Comparator: Control group; Cases managed by uterine lower segment resection without ligation of the anterior division of the internal iliac artery. (i.e., only bilateral ligation at a level below the lower most placental part followed by bilateral uterine artery ligation at the level of the hysterotomy incision).	Procedure: Control group: lower segment resection without ligation of the anterior division of the internal iliac artery; Cases managed by uterine lower segment resection without ligation of the anterior division of the internal iliac artery. (i.e., only bilateral ligation at a level below the lower most placental part followed by bilateral uterine artery ligation at the level of the hysterotomy incision).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Amount of blood loss intra-operative	Amount of blood loss intra-operative	during operation
Amount of blood loss 24 hours post-operative	Amount of blood loss 24 hours post-operative	24 hours post-operative

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Operative time	duration of the surgery	during operation
Number of blood units transfused	Number of blood units transfused within 24 hours after surgery	within 24 hours after surgery

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): July 3, 2022
• Primary Completion (Actual): January 31, 2024
• Study Completion (Actual): January 31, 2024

Study Registration Dates

• First Submitted: July 3, 2022
• First Submitted That Met QC Criteria: July 21, 2022
• First Posted (Actual): July 22, 2022

Study Record Updates

• Last Update Posted (Actual): July 30, 2025
• Last Update Submitted That Met QC Criteria: July 27, 2025
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Obstetric Labor Complications; Pregnancy Complications; Placenta Diseases; Placenta Accreta
• Other Study ID Numbers: MS-38-2022

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No