Edorium Journal of

Gynecology and Obstetrics

 
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Original Article
 
Intraoperative internal iliac artery balloon occlusion versus ligation in cases of placenta previa accreta: A randomized trial
Mohamed Lotfy Mohamed El-sayed1, Ahmed Mohamed El-huseiny1, Mostafa Abdo Ahmed1, Sameh Saber2
1Department of Obstetrics and Gynecology, Faculty of medicine, Zagazig University, Egypt.
2Department of Radiodiagnosis, Faculty of medicine, Zagazig University, Egypt.

Article ID: 100012G06ME2016
doi:10.5348/G06-2016-12-OA-6

Address correspondence to:
Mohamed Lotfy Mohamed El-sayed
Assistant professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology
Faculty of medicine, Zagazig University

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How to cite this article
El-sayed MLM, El-huseiny AM, Ahmed MA, Saber S. Intraoperative internal iliac artery balloon occlusion versus ligation in cases of placenta previa accreta: A randomized trial. Edorium J Gynecol Obstet 2016;2:34–40.


Abstract
Aims: The aim of the study was to compare the efficacy of intraoperative bilateral internal iliac artery balloon occlusion versus bilateral internal iliac artery ligation before extraction of placenta previa accreta after fetal delivery.
Methods: One hundred patients with preoperative diagnosis of placenta previa accreta were randomly allocated into two groups each including 50 patients; Group (A) intraoperative internal iliac artery (IIA) balloon occlusion was undergone and Group (B) internal iliac artery ligation was undergone. Then delivery of the fetus and the placenta was removed in a piecemeal manner; any remaining placental bed bleeding was controlled by different surgical techniques. Statistical analysis: The collected data were computerized and statistically analyzed using SPSS program (Statistical Package for Social Science) version 20. Qualitative data were represented as frequencies and relative percentages and quantitative data were expressed as mean±SD (Standard deviation). We used two statistical tests for detection of the difference between the two studied groups: The student "t" test for comparison of means of quantitative variables of two independent groups and chi-square test was used to calculate difference between qualitative variables and find the association between row and column variables. Both tests are used for normally distributed data.
Case Report: Satisfactory hemostasis was achieved in 33 patients (33/50 = 66%) in IIA balloon occlusion group while hemostasis was achieved in 29 patients (29/50 = 58%) in IIA ligation group, whereas additional surgical interference were performed in (12/50 = 24%) and (15/50 = 30%) of IIA balloon occlusion group and IIA ligation group respectively. Emergent hysterectomy was performed in (5/50=10%) of IIA occlusion group and (6/50 = 12%) of IIA ligation group. Blood transfusion during operation in 36 patients (36/50 = 72%) and three patients on the first 24 hours after the operation while in IIA ligation group blood transfusion during operation in 39 patients (39/50 = 78%) and five patients on the first 24 hour after the operation. The postoperative hospital stay was shorter with IIA occlusion group.
Conclusion: Placenta accreta is a potentially life-threatening condition that carries a high rate of maternal morbidity and mortality. Bilateral internal iliac arteries occlusion before extraction of the placenta seemed to be an effective and safe technique to decrease intrapartum and postpartum complications, and to minimize the risk of the emergent hysterectomy.

Keywords: Internal iliac artery balloon occlusion, Internal iliac artery ligation, Placenta previa accreta


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Author Contributions:
Mohamed lofty Mohamed El-Sayed – Substantial contributions to conception and design, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ahmed Mohamed El-huseiny – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mostafa Abdo Ahmed – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Sameh Mohamed Saber – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Mohamed lofty Mohamed El-Sayed et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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