The effect of uterine artery ligation in patients with central placenta pevia: a randomized controlled trial

Ahmad Sameer Sanad, Ahmad E Mahran, Mahmoud Elmorsi Aboulfotouh, Hany Hassan Kamel, Hashem Fares Mohammed, Haitham A Bahaa, Reham R Elkateeb, Alaa Gamal Abdelazim, Mohamed Ahmed Zeen El-Din, Hossam El-Din Shawki, Ahmad Sameer Sanad, Ahmad E Mahran, Mahmoud Elmorsi Aboulfotouh, Hany Hassan Kamel, Hashem Fares Mohammed, Haitham A Bahaa, Reham R Elkateeb, Alaa Gamal Abdelazim, Mohamed Ahmed Zeen El-Din, Hossam El-Din Shawki

Abstract

Background: Placenta previa is major obstetric surgical risk as it is associated with higher percentage of intraoperative and postpartum hemorrhage (PPH), increased requirement of blood transfusion and further surgical procedures. The current study aimed to evaluate uterine artery ligation prior to uterine incision as a procedure to minimize blood loss during cesarean section in patients with central placenta previa.

Methods: One hundred and four patients diagnosed with central placenta previa antenatally and planned to have elective caesarean section were recruited from the antenatal clinic at Minia Maternity University hospital. Patients were randomly allocated into either ligation group or control group.

Results: Both groups were similar regarding demographic features and preoperative risk factors for bleeding. The intraoperative blood loss was significantly lower in the ligation group as compared with the control group (569.3 ± 202.1 mL vs. 805.1 ± 224.5 mL respectively, p = 0.002). There was a significant increase in the requirement for blood transfusion in the control group as compared with the ligation group (786 ± 83 mL vs. 755 ± 56 mL respectively, p = 0.03) Three cases in the control group required further surgical interventions to control intraoperative bleeding, while no cases in the ligation required further surgical techniques and that was statistically significant (p = 0.001).

Conclusion: Uterine artery ligation prior to uterine incision may be a helpful procedure to minimize intraoperative and postpartum blood loss in cases with central placenta previa.

Trial registration: Retrospectively registered in ClinicalTrials.gov Identifier: NCT02002026 - December 8, 2013.

Keywords: Central placenta previa; Cesarean section; Uterine artery ligation.

Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by scientific ethical committee of the Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University in September 2013. Approval was ascertained from the Institutional Review Board of the Faculty of Medicine, Minia University in October 2013. All procedures performed were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All patients signed informed consent that include their agreement to participate in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow chart. (PET: preeclampsia, LUS: lower uterine segment, CS: caesarean section, APH: antepartum hemorrhage)

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