Ligation of descending uterine artery and compression sutures at the uterine lower segment for ;postpartum bleeding due to pernicious placenta previa / 中华围产医学杂志

ABSTRACT

Objective To evaluate the clinical effect of ligation of the descending branch of uterine artery and compression sutures at the lower uterine segment in managing postpartum bleeding due to pernicious placenta previa. Methods Clinical data of 227 patients with pernicious placenta previa, admitted to Shenzhen Maternity and Child Healthcare Hospital between June 2010 and June 2013, were retrospectively analyzed. Eight-two women,who were admitted between June,2010 to December,2011, receiving B-Lynch sutures combined with uterine lower segment packing after delivering the baby and placenta during cesarean section were assigned as the control group. Another 145 cases, who were admitted between January 2012 to June 2013, receiving ligation of the descending branch of uterine artery and compression sutures at the lower uterine segment, were defined as the observational group. Several indicators during and after the operation were compared between the two groups. T-test or Chi-square test were applied for statistics. Results The duration of operation in the observational group was shorter than in the control [(92±26) vs (106±32) min, t=3.579, P<0.01]. The estimated blood loss during the operation, the total blood loss during the first 24 h after delivery and the blood loss during the operation for placenta percreta in the observational group were all lower than in the control [(1 230±481) vs (1 858±632) ml, (1 475±236) vs (2 482±364) ml, and (2 131±515) vs (2 587±498) ml, t=8.413, 25.295 and 6.484, all P<0.01]. The adjusted postoperative hemoglobin values of the observational group were significantly higher than that of control [(82±21) vs (69±19) g/L, t= - 4.634, P<0.01]. Besides, significant differences were found between the observational and control group on the rates of hysterectomy, blood transfusion, and uterine artery embolization [1%(2/145) vs 7%(6/82), 40%(58/145) vs 66%(54/82), 2%(3/145) vs 12%(10/82), χ2=5.408, 13.945 and 9.904, P < 0.05 or 0.01]. The dosage of Carboprost Tromethamine required was smaller in the observational group [(573±104) vs (729±128) μg, t=9.971, P<0.01]. Conclusions Ligation of descending branch of uterine artery and compression sutures in the lower uterine segment during cesarean section in women with pernicious placenta previa is an effective and simple method to control bleeding resulting reduction of blood loss and the hysterectomy rate.