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

Overview

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

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