Uterine artery ligation as the first-line surgical treatment for postpartum haemorrhage during Caesarean section: a retrospective study

Mei Sin Yiu; Po Lam SO; Lee Ting Kwong

doi:10.12809/hkjgom.24.2.372

Authors

Mei Sin Yiu Department of Obstetrics and Gynecology, Tuen Mun Hospital
Po Lam SO Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Hong Kong SAR, China
Lee Ting Kwong Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Hong Kong SAR, China

DOI:

https://doi.org/10.12809/hkjgom.24.2.372

Keywords:

Postpartum hemorrhage, Treatment outcome, Uterine artery

Abstract

Objective: To examine the efficacy of uterine artery ligation (UAL) with or without subsequent haemostatic procedures in management of postpartum haemorrhage (PPH) during Caesarean section.

Methods: Women who underwent UAL with or without subsequent haemostatic procedures were compared in terms of maternal demographics, antenatal risk factors, delivery details, causes of PPH, sequence of treatment modalities used, and short-term complications.

Results: A total of 173 women underwent UAL with or without subsequent haemostatic procedures. The success rate of haemostasis was 96.5% (167/173) after UAL with or without subsequent haemostatic procedures; it was 81.5% (141/173) after UAL alone. Multivariate analysis revealed that women with prior PPH had a higher risk for haemostasis failure after UAL alone (adjusted odds ratio [aOR]=10.35, p=0.027), whereas women with placenta praevia had a lower risk for haemostasis failure after UAL alone (aOR=0.05, p=0.001). Compared with UAL alone, UAL followed by haemostatic procedures resulted in a higher risk of postoperative complications including haemorrhagic shock (p=0.012), disseminated intravascular coagulopathy (p<0.001), and intensive care unit admission (p<0.001). There were five cases of bowel injury and one case of pelvic vessel injury.

Conclusions: UAL is an effective and safe first-line surgical procedure for management of PPH during Caesarean section, especially for women with placenta praevia.

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