The Effects of Internal Iliac Artery Ligation in Women With Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Abstract Objective: To evaluate the efficacy and safety of internal iliac artery (IIA) ligation in the management of placenta accreta spectrum (PAS). Methods: PubMed, Embase, Scopus, ScienceDirect, Cochrane Library, and Clinical Trials Registry were searched up to December 2024 for studies on IIA ligation in PAS. This PROSPERO-registered review followed PRISMA guidelines and included randomized controlled trials (RCTs) and non-RCTs comparing IIA ligation with no intervention, IIA balloon, uterine artery ligation, or temporary common iliac artery occlusion. Outcomes included intraoperative blood loss, transfusion needs, procedure duration, complications, intensive care unit admission, and hospital stay, with risk of bias assessed using Cochrane criteria and the Newcastle-Ottawa Scale, and evidence quality rated via GRADE. Effect estimates were reported as mean differences or odds ratios (95% confidence interval ( CI )) using fixed- or random-effects models based on heterogeneity ( I 2 ), with P < 0.05 considered significant. Results: A total of 13 studies, including five RCTs and eight non-RCTs, involving 939 participants, met the inclusion criteria and were included in the study. Intraoperative blood loss was evaluated in 10 studies involving 631 participants (299 undergoing IIA ligation and 332 controls). The mean difference was −177.10 mL (95% CI : −701.46–347.27; P = 0.51; I 2 = 95%). Postoperative hemoglobin reduction was analyzed in four studies with 233 participants (109 subjected to IIA ligation and 124 controls), yielding a mean difference of −0.17 g/dL (95% CI : −0.47–0.14, P = 0.29, I 2 = 1%). Blood transfusion was assessed in five studies enrolling 248 participants (125 in the IIA ligation group and 123 controls). The mean difference was found to be −0.06 units (95% CI : −2.08–1.95, P = 0.95, I 2 = 93%). The duration of the procedure was investigated in eight studies comprising 539 participants (271 undergoing IIA ligation and 268 controls). The mean difference was calculated as 12.85 minutes (95% CI : −7.2–32.9, P = 0.21, I 2 = 87%). Conclusion: Current evidence suggests that IIA ligation in PAS may not significantly reduce intraoperative blood loss, transfusion requirements, procedure duration, bladder injury, or hospital stay; however, the available studies are heterogeneous and of variable quality, and further high-quality research is needed to confirm these findings. Registration: CRD42024626882, Date 13/12/2024.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.030 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".