Background: Placenta accreta is becoming a common complication of pregnancy. Hysterectomy has been considered the best therapeutic modality in the context of it, but this represents a problem for patients desiring to preserve the uterus for future fertility. Surgical internal iliac artery ligation (IIAL) is usually utilized to attempt to control obstetric hemorrhage. Ligation of the internal iliac arteries has restricted effectiveness. Either ligation of the anterior division of the internal iliac or uterine artery is often employed in a trial to control postpartum hemorrhage (PPH) before resorting to hysterectomy. Objective: To assess the efficacy of IIAL before bladder dissection during conservative management of cases of the morbidly adherent placenta (MAP) using a cervico-isthmic compression suture. Patients and methods: This randomized control study comprised 42 patients with placenta previa (major and minor); divided into two groups; group A (21 patients with bilateral ligation of IIA) and group B (21 patients without ligation of IIA). Results: The amount of blood loss in group A was more than in group B. There was a statistically significantly higher number of packed RBCs transfused units, total estimated blood loss (liters) in group A vs group B. The rate of hysterectomy was statistically higher among group A than Group B. Conclusion: This study demonstrated that bilateral IIAL, as an intervention to reduce blood loss during conservative management for AIP using cervico-isthmic compression suture (CIC), is not beneficial.
Background: Cesarean delivery (CD) is commonly performed operation in modern obstetrics. The risks of cesarean section (CS) include maternal mortality, hemorrhage, venous thrombosis, infections, and anesthetic complications. Oxytocin is the most commonly used ecbolic agent during management of atonic postpartum hemorrhage. The aim of the current study was to compare between the influence of early IV oxytocin infusion early and the standard administration on intraoperative blood loss during caesarean section. Patients and methods: A randomized controlled clinical trial was conducted at Obstetrics and Gynecology Department of Mansoura University Hospitals. This clinical trial included women aged between 18 and 40 years old admitted for elective CS (low risk). The study population consisted of 80 women who were randomly divided into 2 groups. Intervention group included 40 women who received oxytocin infusion immediately after incision of pelvic peritoneum. Control group included 40 cases who received oxytocin after clamping the umbilical cord. Results: There was no significant difference between both groups in terms of primary post-partum hemorrhage or the need for blood transfusion. However, the mean intraoperative blood loss was significantly lower among females who received early oxytocin prior to uterine incision as compared to the control group who received oxytocin after fetal delivery.
Conclusion:Early administration of oxytocin (before uterine incision) compared to late oxytocin (after clamping of umbilical cord) is associated with significantly lower mean intra-operative blood loss.
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