Role of Bilateral Uterine Artery Ligation in Reducing Incidence of Postpartum Hemorrhage in Cesarean Section in Patients At Risk of Uterine Atony A Randomized Controlled Trial

Abstract

According to national statistics in Egypt, Hemorrhage before and after delivery was the leading direct cause of maternal death (43%), with most hemorrhage deaths due to postpartum hemorrhage. There were 32 maternal deaths with hemorrhage per 100,000 live births. Figures for other causes were much less than hemorrhage (e.g. hypertensive diseases were 18 per 100,000, for sepsis 7 per 100,000, for ruptured uterus 7 per 100,000, for cesarean section 6 per 100,000, for obstructed labor 4 per 100,000, for cardiac disease 11 per 100,000 and for anemia 9 per 100,000). Thus our study was held on the steps of previous studies to assess Assess the efficiency of prophylactic bilateral uterine artery ligation in reducing incidence of postpartum hemorrhage in cesarean section in patients at risk of uterine atony. A prospective randomized controlled clinical trial, this clinical trial was conducted at Ain-Shams University Maternity Hospital in the period from December 2014 till August 2016. The patients were recruited from women attending labor ward to undergo cesarean section. Patients were randomized to 2 groups. 240 patients at risk of uterine atony undergoing cesarean section underwent bilateral uterine artery ligation and received oxytocin. Another 240 patients at risk of uterine atony undergoing cesarean section received oxytocin only. The patients were monitored for the occurrence of postpartum hemorrhage in the form of intra-operative blood loss, intra-operative or post-operative need for surgical measures to stop bleeding, post-operative vaginal bleeding, also drop in hemoglobin and hematocrite 24 hours postoperative beside the need for blood transfusion, the occurrence of endometritis for 6 weeks postpartum. In the current study, no significant difference between Study and Control groups as regards age (p0.751) and BMI (p0.345). In the current study, no significant difference between Study and Control groups as regards parity (p0.138) and Gestational age (p0.938). In the current study, no significant difference between study and control groups regarding risks for atony.

In the current study, Intraoperative blood loss after placental separation was significantly lower among study group than among control group (p<0.001). In the current study, 1st 6 hours Postoperative vaginal bleeding was significantly lower among study group than among control group (p<0.001). In the current study, Total blood loss was significantly lower among study group than among control group (p<0.001). In the current study, No significant difference between study groups regarding basal Hemoglobin (p0.304). 24 hours postoperative Hemoglobin was significantly higher among study group than among control group (p<0.001). Hemoglobin reduction was significantly lower among study group than among control group (p<0.001). In the current study, No significant difference between study groups regarding basal Hematocrit (p0.560). 24 hours postoperative Hematocrit was significantly higher among study group than among control group (p<0.001). Hematocrit reduction was significantly lower among study group than among control group (p<0.001).