Effect of Uterine Artery Ligation Prior to Uterine Incision in Women With Placenta Previa

Cairo University (CU)

Status: Unknown

Conditions: Placenta Previa

Treatments: Procedure: Lower segment Cesarean section; Procedure: uterine artery ligation

Study type: Interventional

Funder types: Other

Identifiers

NCT03124472

169

Details and patient eligibility

About

Pfannenstiel incision of skin and opening of the anterior abdominal wall in layers.

• The loose peritoneum of the lower uterine segment is dissected downwards to mobilize the urinary bladder and expose the lower uterine segment.
• Uterine artery ligation was performed by grasping the broad ligament with thumb anterior and the index finger lifting the base below the site uterine incision; the uterine artery was singly ligated with No. 1 vicryl suture. Myometrium was included so that uterine vessels are not damaged.
• Cresenteric lower uterine segment incision was performed as usual. Higher incisions were performed in cases where the traditional incision was expected to be directly through the placenta Delivery of the baby and placenta.
• Closure of the uterine incision in 2 layers with N0. 1 vicryl suture.
• Closure of the anterior abdominal wall in layers

Full description

Pfannenstiel incision of skin and opening of the anterior abdominal wall in layers.

• The loose peritoneum of the lower uterine segment is dissected downwards to mobilize the urinary bladder and expose the lower uterine segment.
• Uterine artery ligation was performed by grasping the broad ligament with thumb anterior and the index finger lifting the base below the site uterine incision; the uterine artery was singly ligated with No. 1 vicryl suture. Myometrium was included so that uterine vessels are not damaged.
• Cresenteric lower uterine segment incision was performed as usual. Higher incisions were performed in cases where the traditional incision was expected to be directly through the placenta Delivery of the baby and placenta.
• Closure of the uterine incision in 2 layers with N0. 1 vicryl suture.
• Closure of the anterior abdominal wall in layers In the control group, lower segment caesarean section is without uterine artery ligation

Enrollment: 200 estimated patients

Sex: Female

Ages: 19 to 40 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• patients diagnosed with placenta praevia antenatally
• plan is elective caesarean section
• Gestational age >34 weeks

Exclusion criteria

• Fetal distress
• medical disorders as hypertension or Diabetes Mellitus
• Coagulation defects.
• Emergency Cesarean section
• women with antepartum hemorrhage
• patients with marked ahdesions or those with non possible uterine artery ligation

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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200 participants in 2 patient groups

uterine artery ligation

Active Comparator group

Description:

Pfannenstiel incision of skin and opening of the anterior abdominal wall in layers. * The loose peritoneum of the lower uterine segment is dissected downwards to mobilize the urinary bladder and expose the lower uterine segment. * Uterine artery ligation was performed by grasping the broad ligament with thumb anterior and the index finger lifting the base below the site uterine incision; the uterine artery was singly ligated with No. 1 vicryl suture. Myometrium was included so that uterine vessels are not damaged. * Cresenteric lower uterine segment incision was performed as usual. Higher incisions were performed in cases where the traditional incision was expected to be directly through the placenta.

Treatment:

Procedure: Lower segment Cesarean section

Procedure: uterine artery ligation

Traditional lower segment Cesarean section

Active Comparator group

Description:

Pfannenstiel incision of skin and opening of the anterior abdominal wall in layers. * The loose peritoneum of the lower uterine segment is dissected downwards to mobilize the urinary bladder and expose the lower uterine segment. * Cresenteric lower uterine segment incision was performed as usual. Higher incisions were performed in cases where the traditional incision was expected to be directly through the placenta.

Treatment:

Procedure: Lower segment Cesarean section