This study aims to evaluate the efficacy and safety of bilateral internal iliac artery balloon occlusion in the management of the placenta accreta spectrum.
Placenta accreta spectrum (PAS) is abnormal placental adhesion beyond superficial myometrium, which includes placenta accreta, placenta increta, and placenta percreta. However, there is a desire to preserve the uterus and fertility, so alternatives to hysterectomy are needed. Presently, attempts to avoid hysterectomy include reducing intraoperative hemorrhage such as uterine compression sutures, intrauterine balloon tamponade, pelvic artery ligation, and spiral suturing of the lower uterine segment. Intrauterine balloon tamponade may increase CS scar dehiscence, uterine rupture, and infection. Combined with compression sutures, it may induce uterine necrosis. Placement of balloons in the bilateral internal iliac arteries before caesarean section can reduce uterine artery pressure and intraoperative blood loss during balloon inflation, thus temporarily blocking the main blood supply of the uterus, helping to expose the visual field, shortening the operation time during surgery, and leading to opportunities for timely adjustments to the operative plan during surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Patients will be subjected to conventional management for placenta accreta spectrum.
Patients will be subjected to bilateral internal iliac artery balloon occlusion for placenta accreta spectrum.
Tanta University
Tanta, El-Gharbia, Egypt
Amount of intraoperative blood loss
The amount of intraoperative blood loss will be calculated with reference to the contents of the suction apparatus and to weight of the surgical pads and the hemoglobin concentration difference, immediate preoperative (the morning of cesarean delivery) and postoperative (immediately after cesarean delivery) hemoglobin levels.
Time frame: Intraoperatively
Operation time
Operation time will be recorded from start till end of surgery.
Time frame: From the start till the end of surgery
Number of blood products units transfused
Number of blood products units transfused will be recorded.
Time frame: 24 hours postoperatively
Hospitalization length
Hospitalization length will be recorded from admission till discharge from hospital.
Time frame: 28 days postoperatively
Incidence of hysterectomy
Incidence of hysterectomy will be recorded.
Time frame: 24 hours postoperatively
Intensive Care Unit (ICU) admission rate
Intensive Care Unit (ICU) admission rate will be recorded.
Time frame: 24 hours postoperatively
Intraoperative complications
Intraoperative complications such as bladder injury, ureteric ligature, and uterine atony will be recorded.
Time frame: Intraoperatively
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