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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Clamp | Experimental | In these patients, we clamped the uterine artery by Darmklemmen clamp after the delivery of the baby before the delivery of placenta. We released the clamp after the suturing of the uterus is finished. |
|
| Control | No Intervention | Routine Cesarean section is done. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Clamping the uterine artery bilaterally during Cesarean section | Procedure | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| The rate of blood loss | by measuring the suction canister | during C-section |
| The rate of blood loss | by weighting the gauze+abdominal compress+under pads used during C-section after subtracting the tare | during C-section |
| The rate of blood loss | by comparing the preoperative and postoperative hemoglobin and hematocrit values | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Operation time | minutes | during C-section |
| Postoperative complications | need for relaparatomy, vascular or organ injury | postoperative 48 hours |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ismail Cepni, Prof | Istanbul University - Cerrahpasa | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Istanbul University-Cerrahpasa | Istanbul | 34098 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40495474 | Derived | Cepni I, Hamzaoglu Canbolat K, Ozcivit Erkan IB, Sayili U, Yuksel Ozgor B, Ozak E, Mahmudova A, Madazli R, Ocal KP. The Cepni modification: using bilateral vascular clamps during caesarean section for intrapartum hemorrhage, a randomized controlled trial. J Turk Ger Gynecol Assoc. 2025 Jun 10;26(2):73-81. doi: 10.4274/jtgga.galenos.2025.2024-10-4. |
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All of the individual participant data collected during the trial, will ve shared after de identification. The data will be available immediately following publication. No end date. The data will be shared to anyone who wishes to access the data. It could be used for any purpose. Data will be available to anyone who proposes. Proposals should be directed to ipekbetulozcivit@gmail.com, and the link will be provided.
The data will be available immediately following publication. No end date.
The data will be shared to anyone who wishes to access the data.
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|
| neonatal outcomes | APGAR scores | during C-section |
| ID | Term |
|---|---|
| D006473 | Postpartum Hemorrhage |
| ID | Term |
|---|---|
| D007744 | Obstetric Labor Complications |
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D011644 | Puerperal Disorders |
| D014592 | Uterine Hemorrhage |
| D006470 | Hemorrhage |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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