Application of ligation of ascending branch of uterine artery combined with ligation of the utero-ovarian artery anastomoses for hemostasis in cesarean section

Abstract

Background: Postpartum hemorrhage is a life-threatening pregnancy complication, which is still the main preventable cause of high morbidity and mortality in pregnant women.During cesarean section,lower uterine segment hemorrhage is an important cause of postpartum hemorrhage.We aim to evaluate the efficacy and safety of the application of "ligation of the ascending branch of uterine artery combined with ligation of the utero-ovarian artery anastomoses" for hemostasis during cesarean section. Methods: 47 patients admitted to the Second Department of Obstetrics and Maternity of Fujian Maternal and Child Care Service Center from March 2018 to March 2022 were collected. There were 11 cases of placenta previa with placenta implantation and scar uterus. Placenta previa with placenta implantation in 3 cases; Placenta previa combined with twin in 1 case; Placenta previa with scar uterus in 12 cases; Placenta previa in 3 cases; Placenta implantation complicated with severe preeclampsia and scar uterus in 1 case; Placenta implantation with scar uterus in 1 case; Placental implantation in 2 cases; 1 case of twin with uterine myoma and 1 case with cicatricial uterus; 1 case of twin with severe preeclampsia; There were 2 simple twins; Breech in 1 case; Placental abruption: 1 case; Uterine fibroids in 3 cases; Scar uterus: 3 cases. In all cases, intravenous injection of 100 micrograms of carbetin was routinely used to promote uterine contraction after delivery of the fetus. For those who still had diffuse bleeding in the lower segment of the uterus after ligation of the ascending branch of the uterine artery，combined suture was performed to ligate the the utero-ovarian artery anastomoses, and the short and long term prognosis, uterine were analyzed. Results: All 47 patients were successfully hemostatic and no hysterectomy was performed. Conclusions: Ligation of the ascending branch of uterine artery combined with ligation of the utero-ovarian artery anastomoses is one of the fast, safe, effective and feasible hemostasis methods in cesarean section. The combination of the latter can block the uterine blood flow and further reduce the amount of intraoperative bleeding, especially for uterine body bleeding, which can be more rapid and effective hemostasis.