Cesarean Section Complications, Postpartum Hemorrhage
Conditions
Keywords
postpartum hemorrhage, cesarean section
Brief summary
The rate of heavy blood loss is higher in Cesarean delivery compared to vaginal deliveries. Since postpartum hemorrhage is a life threatening situation to decrease the maternal mortality and morbidity rates, precautions should be taken. In this study, we aim to decrease the amount of postpartum hemorrhage by clamping the uterine artery after the delivery of the baby during Cesarean delivery.
Detailed description
Obstetrical hemorrhage, is the most common cause of maternal mortality and morbidity that could be prevented. It can appear at early and late stage of delivery and after delivery. It Is defined as loss of more than 500 mL of blood in vaginal deliveries, whereas more than 1L of blood during C-section. The rate of heavy blood loss is higher in Cesarean delivery compared to vaginal deliveries. The incidence of postpartum anemia in Europe is 50% while in developing countries like Turkey it rises up to 50-80%. Since postpartum hemorrhage is a life threatening situation to decrease the maternal mortality and morbidity rates, precautions should be taken. To preserve the hemoglobin concentrations and hemostasis and to optimize the patient's results, evidence-based methods should be performed. Given these circumstances, interventions using pharmacological, mechanical and surgical methods are necessary to minimize the blood loss. Uteroronics are the first line treatment options followed by fundal massage, controlled traction of cord and delivery of placenta, bimanual compression, intrauterine hydrostatic balloon. After these interventions, surgical interventions such as compression sutures, bilateral uterine artery ligation, hysterectomy and pelvic tamponade could be performed. In this study, we aim to decrease the amount of preoperative part of postpartum hemorrhage by clamping the uterine artery by Darmklemmen clamp after the delivery of the baby before the delivery of placenta during Cesarean delivery.
Interventions
PROCEDUREClamping the uterine artery bilaterally during Cesarean section
We clamped the uterine artery by Darmklemmen clamp, which grasps the tissue delicately without damage, after the delivery of the baby before the delivery of placenta. The clamp is released after the suturing of Munro-Kerr incision is finished, before bleeding control. The duration of clamping time is recorded.
Sponsors
Istanbul University - Cerrahpasa
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
Yes
Inclusion criteria
* Women gave birth \>37 GW * singleton pregnancy * with normal fetal development * Not emergency C-section
Exclusion criteria
* C/sections with indications of plasenta prevue or placenta acrreta spectrum * with amniotic fluid abnormalities * multiple pregnancies * threatened preterm labor * who have preeclampsia or other type of obstetrical complications * maternal obesity (BMI\>30kg/m2) * maternal cardiovascular disease, hypertension, coagulation defects, women who use anticoagulants * patients who underwent Cesarean section during active labor
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The rate of blood loss | during C-section | by measuring the suction canister |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Operation time | during C-section | minutes |
| Postoperative complications | postoperative 48 hours | need for relaparatomy, vascular or organ injury |
| neonatal outcomes | during C-section | APGAR scores |
Countries
Turkey (Türkiye)
Outcome results
None listed