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

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.

References

World Health Organization. WHO recommendations on the assessment of postpartum blood loss and use of a treatment bundles for postpartum haemorrhage. Accessed 10 March 2024. Available from: https://www.who.int/publications/i/item/9789240085398.

World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Accessed 10 March 2024. Available from: https://www.who.int/publications/i/item/9789241548502.

Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv 2007;62:540-7.

O’Leary JA. Uterine artery ligation in the control of postcesarean hemorrhage. J Reprod Med 1995;40:189-93.

Howard LR. Iatrogenic arteriovenous sinus of a uterine artery and vein. Report of a case. Obstet Gynecol 1968;31:255-7.

Bouchghoul H, Madar H, Resch B, et al. Uterine-sparing surgical procedures to control postpartum hemorrhage. Am J Obstet Gynecol 2024;230:S1066-S1075.e4.

Nabhan AE, AbdelQadir YH, Abdelghafar YA, et al. Therapeutic effect of internal iliac artery ligation and uterine artery ligation techniques for bleeding control in placenta accreta spectrum patients: a meta-analysis of 795 patients. Front Surg 2022;9:983297.

B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol 1997;104:372-5.

Palacios-Jaraquemada JM. Efficacy of surgical techniques to control obstetric hemorrhage: analysis of 539 cases. Acta Obstet Gynecol Scand 2011;90:1036-42.

Lalonde A; International Federation of Gynecology and Obstetrics. Prevention and treatment of postpartum hemorrhage in low‐resource settings. Int J Gynecol Obstet 2012;117:108‐18.

Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol 2017;130:e168-e186.

Schlembach D, Helmer H, Henrich W, et al. Peripartum haemorrhage, diagnosis and therapy. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry No. 015/063, March 2016). Geburtshilfe Frauenheilkd 2018;78:382-99.

Escobar MF, Nassar AH, Theron G, et al. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet 2022;157(Suppl 1):3-50.

Joshi VM, Shrivastava M. Partial ischemic necrosis of the uterus following a uterine brace compression suture. BJOG 2004;111:279-80.

Ochoa M, Allaire AD, Stitely ML. Pyometria after hemostatic square suture technique. Obstet Gynecol 2002;99:506-9.

Kwong LT, So PL, Wong SF. Uterine compression sutures with additional hemostatic procedures for the management of postpartum hemorrhage. J Obstet Gynaecol Res 2020;46:2332-9.

Fahmy K. Uterine artery ligation to control postpartum hemorrhage. Int J Gynaecol Obstet 1987;25:363-7.

Epstein D, Solomon N, Korytny A, et al. Association between ionised calcium and severity of postpartum haemorrhage: a retrospective cohort study. Br J Anaesth 2021;126:1022-8.

Samy A, Ali MK, Abbas AM, et al. Randomized controlled trial of the effect of bilateral uterine artery ligation during cesarean among women at risk of uterine atony. Int J Gynaecol Obstet 2020;148:219-24.

Lin J, Lin F, Zhang Y. Uterine artery ligation before placental delivery during caesarean in patients with placenta previa accreta. Medicine (Baltimore) 2019;98:e16780.

Downloads

Published

2024-05-06

How to Cite

1.
Yiu MS, SO PL, Kwong LT. Uterine artery ligation as the first-line surgical treatment for postpartum haemorrhage during Caesarean section: a retrospective study. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2024 May 6 [cited 2024 Jul. 13];24(2). Available from: https://hkjgom.org/home/article/view/372

Issue

Section

Original Article (Obstetrics)

Most read articles by the same author(s)