Group A: In which 86 patients will have bilateral uterine artery ligations as described by O- lreay technique in addition to standard conservative methods. Briefly, two large vicryl stitches were passed using a large-sized needle below and lateral to the lower edge of the uterine incision angle in an anteroposterior direction and then redirected from back to the front through the avascular window in the posterior leaf of the broad ligament just lateral to the uterine border taking care to avoid injury to bowel posteriorly or bladder/ureter anteriorly. The stitches were tied securely anteriorly

Group B: which will include 86 patients we will do our simplified approach which includes;

• After placental separation; try to grasp the lower segment or cervical flap.

• Close uterine cavity by continuous vicryl no 1 suture.

• Do 3 to 4 mattress sutures as the second layer of the uterus.

• Do uterine ligation with compression of the lower uterine segment (Modification of O, lreay suture) as demonstrated below:

  1. Pack Douglas- pouch with a towel.
  2. Straight the used vicryl needle mostly no 1.
  3. Try to compress and approximate anterior and posterior uterine walls.
  4. Start from anterior to posterior 3- 4 cm medial to lateral uterine margin and then pass from posterior to anterior through avascular area in the broad ligament.

bilateral uterine artery ligations as described by O- lreay technique in addition to standard conservative methods. Briefly two large vicryl stitches were passed using a large sized needle below and lateral to the lower edge of the uterine incision angle in anteroposterior direction and then redirected from back to the front through avascular window in the posterior leaf of the broad ligament just lateral to the uterine border taking care to avoid injury to bowel posteriorly or bladder/ureter anteriorly. The stitches were tied securely anteriorly

The primary outcome for the study is the total volume of blood loss in the intra and postoperative period.

Coagulopathy, need for massive blood transfusion (> 4 units), length of hospital stay, and visceral injuries ICU admission and post-operative pain.

Gynecological complications as amenorrhea, intrauterine adhesions and niche formation.