Prophylactic hypogastric arterial ligation before cesarean hysterectomy for controlling complications in pregnant women with placenta adherent abnormality A randomized controlled clinical trial

• Published in: Journal of research in medical sciences Vol. 27; no. 1; p. 63
• Main Authors: Movahedi, Minoo, Niakan, Zahra, Shahshahan, Zahra, Hooshmand Meibodi, Amir Reza, Babak, Anahita, Saeidi, Mahmoud
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01-01-2022; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Clinical trials; deep vein thrombosis; Health aspects; hemorrhage; hypogastric; Hysterectomy; Original; placenta accrete; Pregnant women; Product development; Surgery; Tranexamic acid; Women; Iran
• DOI: 10.4103/jrms.jrms_763_21
• EISSN: 1735-7136
• ISSN: 1735-1995

BackgroundPlacenta adherent abnormality (PAA) is abnormal attachment of the placenta to the myometrium. This abnormal placenta binding has severe clinical consequences for the mother and the fetus. We investigated the outcomes of hypogastric arterial ligation (HAL) before hysterectomy compared to hysterectomy alone in pregnant women with PAA. Materials and MethodsIn this randomized controlled clinical trial, 70 patients were randomly allocated to HAL along with hysterectomy and hysterectomy alone groups (35 in each Group). The total amount of intraoperative blood loss, the need for intraoperative blood products transfusion, frequency of deep vein thrombosis, duration of surgery, duration of hospitalization, and visceral trauma were compared between 2 Groups. ResultsFinally, 64 patients completed the study protocol with mean age of 33.84 ± 4.25 years. The study groups were comparable in terms of basic baseline demographic and clinical characteristics. Visceral trauma was less frequently occurred in HAL group compared to hysterectomy alone (0% vs. 15.6%; P = 0.02). Intraoperative blood loss (1525 ± 536.41 cc vs. 2075 ± 889.36 cc; P = 0.001) and were significantly lower in HAL group compared to hysterectomy alone. Duration of operation (179.06 ± 36.28 vs. 197.66 ± 39.47; P = 0.05) and hospitalization (4.97 ± 2.20 vs. 6.10 ± 2.39; P = 0.03) also were significantly lower in HAL group. ConclusionOur findings suggest that prophylactic HAL has a protective effect on the reduction of blood loss and less visceral trauma in pregnant women with PAA.