Combined Internal Iliac Artery Ligation, Transverse B-Lynch Suture and Intrauterine Balloon to Control Bleeding from Placenta Accreta during Caesarean Delivery

Abstract

Introduction and aim: Placenta praevia and accreta are associated with high morbidity and mortality. Bleeding is the sole etiology of both morbidity and mortality. Thus, anti-bleeding measures are mandatory and research continues to search for ideal prophylactic measure. This work was designed to assess the efficacy of bilateral internal iliac artery ligation followed by Transverse B-Lynch compression suturing and intrauterine balloon tamponade as a conservative methods to control placental site bleeding due to placenta praevia accreta.
 Methodology: The study included 24 pregnant females with placenta praevia accreta who were scheduled for elective cesarean section. All participants were subject to history taking, clinical evaluation and laboratory investigations. Ultrasound examination was carried out for assessment of: Estimated fetal weight, confirmation of gestational age, confirm diagnosis of placenta previa accreta and level of the placental edge in lower uterine segment. Deliveries were scheduled to take place between 36-37 weeks of gestation. The primary outcome was the amount of intra-operative blood loss.
 Results: Blood loss ranged between 249.29 and 560.43 ml, and there was statistically significant decrease of hematocrit percent and platelets after surgery when compared to corresponding values before surgery. All females need blood transfusion. However, none of them need further surgical intervention or intensive care unit admission.
 Conclusion: Prophylactic bilateral internal iliac artery ligations before extraction of placenta accreta followed by transverse B Lynch suture and intrauterine balloon tamponade seemed to be an effective and safe technique to reduce intrapartum and postpartum complications, and to avoid emergent peripartum hysterectomy.

Internal Iliac Artery Ligation in Obstetrics and Gynecology: Surgical Anatomy and Surgical Considerations

“…IIA ligation appears to be a safe procedure that does not impair subsequent fertility and pregnancy outcomes even in combination with other fertility procedures of the uterus (Bakri balloon and B-Lynch suture [ 73 , 74 , 75 , 76 ]. Nizard et al [ 10 ] reported a series of pregnancies following IIA ligation, with normal pregnancy outcomes and no observed infertility among their population.…”