title: Limitations of internal iliac artery ligation for the reduction of intraoperative hemorrhage during cesarean hysterectomy in cases of placenta previa accreta.
abstract: OBJECTIVE
  Our purpose was to evaluate the effect of internal iliac ligation as a bleeding control during cesarean hysterectomy for placenta accreta.
  
  
  METHODS
  We retrospectively reviewed the cases of placenta accreta receiving cesarean hysterectomy during the period of 1987-2006 in the Saitama Medical Center. The clinical outcomes of these patients either receiving or not receiving internal iliac artery ligation were compared in terms of bleeding amount, and length of hospitalization. The bleeding amounts in the variants of placenta accreta managed with internal iliac artery ligation were also analyzed to determine whether the different pathological findings would affect blood loss during cesarean hysterectomy.
  
  
  RESULTS
  Among 23 cases, the mean blood loss during the operation and the length of hospitalization after the operation, with or without internal iliac artery ligation (IIAL) were not significantly different. There was no significant difference between the mean blood loss and the pathological findings of cases managed with IIAL.
  
  
  CONCLUSIONS
  In cases of placenta previa accreta, ligation of the internal iliac artery did not significantly contribute to hemostasis during cesarean hysterectomy.
authors.affiliation: Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Tsujido-machi, Kamoda, Kawagoe-shi, Saitama 350-8550, Japan. fwbc6097@nifty.com
authors.forename: Atsushi
authors.initials: A
authors.lastname: Iwata
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Murayama
authors.forename: Atsuo
authors.initials: A
authors.lastname: Itakura
authors.forename: Kazunori
authors.initials: K
authors.lastname: Baba
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Seki
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeda
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002585:Cesarean Section / Q000009:adverse effects; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007083:Iliac Artery / Q000601:surgery*; D008026:Ligation; D010921:Placenta Accreta / Q000601:surgery*; D010923:Placenta Previa / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome