Uterine Artery Color Doppler Parameters After Bilateral Uterine Artery Ligation
Condition: Postpartum Hemorrhage; Ligation; Color Doppler; Uterine Artery
MeSH terms: Postpartum Hemorrhage; Hemorrhage
Study type: Interventional

Summary: 
      The aim of this study is to assess Uterine artery color doppler parameters after bilateral
      uterine artery ligation (BUAL) for Postpartum Hemorrhage.
    

Detailed description: 
      Obstetric haemorrhage is the main reason of maternal death in both countries with high and
      poor incomes. Most of these deaths occurred within the first 24 hours following birth.
      Placenta accrete, retained placenta, genital tract lacerations, uterine rupture, and
      coagulation abnormalities are established risk factors for postpartum hemorrhage. The
      management of Idiopathic pulmonary hemosiderosis (IPH) and postpartum hemorrhage relies on
      numerous considerations: type of delivery (vaginal or caesarean delivery), bleeding etiology
      (uterine atony, trauma, retained placenta) and hemodynamic stability.

      In the first stage, early identification, and treatment with uterotonics, suturing the
      lacerations, and fundal massage are crucial. When bleeding persist, even in the aggressive
      medical treatment, suitable surgical intervention should be performed.

      Surgical therapy relies on the patient's desire to maintain fertility, the severity of the
      bleeding, and the surgeon's experience.

      Historically, peripartum hysterectomy was the only available management to prevent postpartum
      hemorrhage but, in some instances, hysterectomy alone is insufficient to control the
      bleeding.

      Also, the desire to preserve fertility have resulted in the development of other techniques,
      such as pelvic embolization and internal iliac artery ligation (IIAL)and bilateral uterine
      artery ligation (BUAL).

      Bilateral uterine artery ligation (BUAL) is the most popular surgical procedure for quick
      management of postpartum hemorrhage. It may be performed alone or with conjugation with other
      postpartum hemorrhage methods in with success rate exceeds 90 %. Recanalization is a natural
      process that may occur following vascular structure closure with a suture or radiological
      embolization.
    

Intervention name(s): Control group; BUAL group
Intervention type(s): Procedure; Procedure
Intervention description(s): Women will undergo normal cesarean section without Postpartum Hemorrhage or Idiopathic pulmonary hemosiderosis (IPH); Bilateral Uterine Artery Ligation Technique:
All uterine surgeries will be conducted by externalizing the uterus as much as possible and holding it by the fundus. The BUAL will be done using absorbable suture no. 1 Vicryl (Vicryl 1, Ethicon, France, Neuvilly-sur-Seine, France) will be placed through an avascular space in the broad ligament and tied from the anterior to posterior aspects of the myometrium 2-3 cm medial to the descending portion of the uterine vessels. In all patients, the suture will be carried from the anterior to the posterior at 1 cm to the myometrium medial to the Uterine artery and will be knotted after passing it through the avascular region at 1 cm to the wide ligament section adjacent to the uterus in both sides. All patients will be examined for uterotonics during and after the surgery. The ovarian arteries will be assessed at the level of the ovarian hilum.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention