Comparison between Placental Site Injection of Vasopressin and Bilateral Internal Iliac Artery Ligation to Reduce Blood Loss during Cesarean Section for Placenta Praevia, A Randomized Controlled Trial

Background: placenta praevia is an obstetric complication in which the placenta is inserted partially or completely in the lower uterine segment, A significant proportion of these cases is associated with life threatening hemorrhage during delivery, often by caesarean section in the vast majority of cases, many procedures introduced to overcome this problems, none of them is completely successful.
Aim of the work:  this study aimed to compare between local vasopressin injection in the placental bed and bilateral internal iliac artery ligation on the blood loss during caesarean section for placenta praevia.
Patients and Methods: this a randomized-controlled prospective trial included 60 pregnant women with a diagnosis of placenta praevia, they were categorized into 3 equal groups according to methods to control blood loss during cesarean section for placenta praevia. Group 1 included 20 pregnant women who underwent vasopressin injection at placental site. Group 2 included 20 pregnant women who underwent bilateral internal iliac artery ligation. Group 3 included 20 pregnant women   who underwent caesarean section without internal iliac artery ligation or local injection of vasopressin (The control group), comparison between groups were done and statistically analyzed.
Results: there were statistical significant differences between the intervention and the control groups as regard estimated blood loss, Pvalue was  <0.001;  group 3(Control)  had more amounts of blood loss,there were no  statistical significant differences between group 1 and group 2 as  regard estimated blood  loss,  P value  was > 0.05 . Comparison between group1 and  group 2 showed that internal iliac artery ligation was significantly associated with prolonged operative time than vasopressin injection(Pvalue was <0.001). Conclusion and Recommendation: local injection of vasopressin at placental site seemed to be a promising modality for reducing blood loss during cesarean delivery for placenta praevia and was associated with similar reduction of blood loss and less operative time when compared with internal iliac artery ligation, may be done first before trying internal iliac artery ligation and needs no experience.