The Role of Bilateral Internal Iliac Artery Ligation in Minimizing Blood Loss Prior to Cesarean Hysterectomy Patients with Abnormally Invasive Placenta

Background Abnormally invasive placenta (AIP) is a term that describes cases in which there is complete or partial failure of separation of the placenta from the uterine wall following delivery of the fetus. Objective to detect the role of bilateral internal iliac artery ligation in minimizing blood loss, prior to performing Cesarean Hysterectomy in cases with confirmed preoperative or intraoperative diagnosis of Abnormally invasive placenta. Patients and Methods The study was carried out at Ain shams university maternity hospital in 2019. Women were recruited from the labor ward who underwent CS Hysterectomy. The total number of pregnant women enrolled in the study was 95 women. Approval from the Medical Ethics Committee were obtained. Results Our study showed that internal iliac artery ligation in CS hysterectomy cases for AIP has non significant lower blood loss than cases who did not underwent internal iliac artery ligation. In stead, it had increased the operative time. In comparison of 45 patients underwent internal iliac artery ligation and 45 without ligation blood loss was non significantly lower in the group who underwent ligation with mean 1933 ml blood loss in comparison with 2117 ml in the group who did not. Conclusion Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.

Temporary Cross-Clamping of the Infrarenal Abdominal Aorta during Cesarean Hysterectomy to Control Operative Blood Loss

Temporary cross-clamping of the infrarenal abdominal aorta to reduce bleeding during hysterectomy following cesarean section in patients with placenta previa-accreta is a relatively simple procedure; therefore, it can be an option when intravascular balloon catheter placement is impossible or encountered massive bleeding of the unexpected placenta accreta.

Urinary Incontinence after Planned Cesarean Hysterectomy for Placenta Accreta

<b><i>Introduction:</i></b> Data regarding the risk of incontinence after cesarean hysterectomy are lacking. We aimed to assess the risk of urinary incontinence in women who underwent planned cesarean hysterectomy for placenta accreta. <b><i>Methods:</i></b> This was a retrospective study of women who underwent planned cesarean hysterectomy for placenta accreta. The primary outcome was the incidence of post-cesarean hysterectomy urinary incontinence, defined as involuntary loss of urine between 3 and 12 months after cesarean hysterectomy. Outcomes were compared in a cohort of women who underwent planned cesarean hysterectomy for placenta accreta with a control group of women who underwent scheduled cesarean section without hysterectomy. <b><i>Results:</i></b> Forty-seven singleton gestations who underwent planned cesarean hysterectomy for placenta accrete were included in the study and were compared with 100 controls. Eight cases of bladder injuries were reported, 7 in the planned cesarean hysterectomy group and one in the planned cesarean delivery group. Overall, urinary incontinence was reported in 10 women of the planned cesarean hysterectomy group and in 8 women of the planned cesarean section group (21.3% vs. 8.0%; <i>p</i> = 0.03). <b><i>Conclusion:</i></b> Planned cesarean hysterectomy for placenta accreta is a risk factor for urinary incontinence.

Cesarean Hysterectomy in Abnormally Invasive Placenta: The Role of Prenatal Diagnosis

An abnormally invasive placenta (AIP) is a placenta that cannot be removed spontaneously or manually without causing severe bleeding. It is a dangerous condition associated with a high rate of maternal and perinatal morbidity and mortality due to the high rate of massive bleeding and visceral injuries. The standardized ultrasound diagnostic criteria have helped improve its early diagnosis, which is essential to plan coordinated actions to reduce associated morbimortality. We present a case report in which ultrasound diagnosis played a decisive role, enabling the coordination of a multidisciplinary team and improving the immediate care of both mother and newborn. Cesarean hysterectomy was performed with minimal blood loss and a good postsurgical recovery.