Randomized controlled trial of the effect of bilateral uterine artery ligation during cesarean among women at risk of uterine atony

OBJECTIVE: To assess the effectiveness of prophylactic bilateral uterine artery ligation (BUAL) in reducing the incidence of postpartum hemorrhage (PPH) during cesarean delivery among women at risk of uterine atony. METHODS: A randomized clinical trial at Cairo University Maternity Hospital, Egypt, from December 2017 to December 2018. Women at risk of uterine atony undergoing scheduled or emergency cesarean were randomized to two groups. In the BUAL group, women underwent BUAL before placental delivery; in the control group, women had cesarean delivery without BUAL. The primary outcome was the estimated blood loss during cesarean. RESULTS: Intraoperative blood loss during cesarean was significantly lower in the BUAL group than in the control group (523.4 +/- 41.0 vs 619.6 +/- 36.1 mL; P=0.003). Blood loss in the first 6 hours after cesarean was also significantly lower in the BUAL group than in the control group (246.1 +/- 21.4 vs 326.1 +/- 18.5 mL; P=0.006). There was no difference in operative time between the two groups (52.1 +/- 6.1 vs 52.2 +/- 6.8, P=0.880). CONCLUSION: BUAL during cesarean was found to be an effective method for decreasing blood loss during and after cesarean delivery among women at risk of uterine atony and subsequent PPH. CLINICALTRIALS.GOV: NCT03591679.