Effect of Uterine Artery Clamping in Reducing Cesarean Hysterectomy in Pregnancies Complicated by Placenta Accrete Spectrum

Abstract

Background and objective: The placenta accreta spectrum is a major public health problem. Many interventional measures are used for controlling hemorrhage and preventing emergency caesarean hysterectomy. The aim of this study was to evaluate the role of uterine artery clamping in reducing maternal morbidity and mortality in pregnancies complicated by placenta accrete spectrum. Methods: This is a retrospective case-control study implemented in the Sulaymaniyah Maternity Teaching Hospital in Sulaymaniyah city, Kurdistan region-Iraq through the period of 2 years from 1st of June 2020, to 31st of May, 2022. A sample of sixty pregnant women with placenta accreta spectrum surgically managed by elective cesarean section and divided into two study groups (32 women underwent elective cesarean section with uterine artery clamping [interventional group] and 28 women underwent elective cesarean section without uterine artery clamping [control group]). Results: The postoperative hemoglobin level was significantly higher in women of the interventional group with a mean of (10.1±0.7 gm/dL) compared to (9.3±1 gm/dL) in women of the control group. The mean of units of blood transfused was significantly lower in women of the interventional group with a mean of (1.3±0.6 units) compared to (3.1±1.4 units) in women of the control group. Also, there was a significant reduction in units of fresh frozen plasma in women of the interventional group with a mean of (0.9±0.6 units) compared to (2.9±1.5 units) in women of the control group. Conclusions: The uterine artery clamping before placental separation is helpful in reducing the rate of maternal morbidity and mortality in pregnancies complicated by placenta accreta spectrum.