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.

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.

Clusterin and Its Potential Regulatory microRNAs as a Part of Secretome for the Diagnosis of Abnormally Invasive Placenta: Accreta, Increta and Percreta Cases

Magnetic resonance imaging (MRI) and ultrasound methods used for the diagnosis of an abnormally invasive placenta (AIP) have a wide range of sensitivity (Se, 33–93%) and specificity (Sp, 71–100%) levels, which results in a high risk of unfavorable maternal and perinatal outcomes. The relevance of optimizing the diagnosis of AIP is beyond doubt. Given the epigenetic nature of trophoblast invasion, we aimed to quantitate microRNAs and proteins of their target genes that are potentially associated with AIP in blood plasma samples from 64 pregnant women at gestation weeks 30–34 by reverse transcription coupled with polymerase chain reaction (RT-PCR) and Western blotting, respectively. Statistically significant increases in the expression levels of hsa-miR-17-5p, hsa-miR-21-5p, hsa-miR-25-3p, hsa-miR-92a-3p, and hsa-miR-320a-3p were revealed in the groups of women with AIP (accreta, increta, percreta) relative to the group of women with scars on the uterus or to the group with placenta previa. Opposite changes in the expression level of “gene–target protein/miRNA” pairs were found for the α-subunit of the clusterin secretory form and any of the hsa-miR-21-5p, hsa-miR-25-3p, hsa-miR-92a-3p, hsa-miR-320a-3p, and hsa-miR-17-5p in all cases of AIP. The developed logistic regression models to diagnose AIP cases of various severity gave Se values of 88.8–100% and Sp values of 91.6–100% using a combination of hsa-miR-21-5p, hsa-miR-92a-3p, hsa-miR-320a-3p, or clusterin levels.