The Çepni modification: using bilateral vascular clamps during caesarean section for intrapartum hemorrhage, a randomized controlled trial.

Objective: Our aim was to reduce blood loss during C-section through the intraoperative temporary occlusion of the bilateral uterine vascular bundles.

Material and methods: This randomized controlled study included 99 singleton pregnant patients at 37 weeks of gestation or later, with normal fetal development and no obstetric complications, attending a university hospital. In the intervention group (n=45), bilateral occlusion of the uterine vascular bundles at their entry point to the uterus was performed using atraumatic Darmklemmen clamps after the delivery of the baby. In the control group (n=54), routine C-section was performed. Our primary outcome was the amount of blood loss, measured using the suction canister, gauze and abdominal mops and underpads after the operation, along with the comparison of preoperative and postoperative hemoglobin and hematocrit values. Our secondary outcomes were operative time, transfusion rate, maternal outcomes (including postoperative complications during follow-up), and neonatal outcomes.

Results: In the intervention group, blood loss measured in gauze, abdominal compress pads, underpads and total blood loss were significantly lower than in the control group (p=0.031, p=0.001, p=0.003, and p=0.010, respectively). The mean decrease in hematocrit value was 5.3±2.67% in the intervention group and 4.85±2.53% in the control group (p>0.05). Operative time and neonatal outcomes were similar between the two groups. No perioperative or postoperative complications were observed during follow-up.

Conclusion: Bilateral temporary occlusion of the uterine vascular bundles using atraumatic clamps was a feasible and safe technique for reducing blood loss during cesarean section without adverse maternal and neonatal outcomes. Trial registration number and date of registration: NCT05948436- July 10, 2023.