Efficacy of uterine artery ascending branch ligation for preventing postpartum hemorrhage in Caesarean section for placenta previa

BACKGROUND: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality globally. This study aimed to assess the efficacy of ascending uterine artery ligation (AUAL) in preventing PPH among patients undergoing cesarean section (CS) for placenta previa. METHODS: A retrospective cohort study was conducted at our institution between January 2022 and December 2024, enrolling 103 patients with placenta previa who underwent CS with concurrent AUAL. A matched control group was included, comprising 134 patients with placenta previa who underwent CS with administration of specialized uterotonic agents (without AUAL). All participants in both groups received intraoperative and postoperative oxytocin administration. Demographic characteristics and clinical outcomes were compared between the two groups, including maternal age, gestational age at delivery, parity, total surgical duration, 24-hour postpartum blood loss volume, postoperative hemoglobin concentration, occurrence of puerperal fever, and rate of uterine involution. Postoperative abdominal pain intensity was assessed via the Numerical Rating Scale (NRS). RESULTS: No statistically significant differences were observed between the AUAL group and the control group regarding maternal age, gestational age at delivery, parity, uterine involution rate, or the incidence of puerperal fever (P > 0.05). Notably, the AUAL group had significantly lower total 24-hour postpartum blood loss (495.3 ± 159.9 ml vs. 648.1 ± 246.8 ml, P < 0.001) and a smaller reduction in postoperative hemoglobin (12.8 ± 5.5 g/L vs. 16.8 ± 6.8 g/L, P < 0.001) compared with the control group. However, the AUAL group was associated with a significantly longer operative time (1.9 ± 0.4 h vs. 1.7 ± 0.5 h, P = 0.025) and more severe postoperative abdominal pain. CONCLUSIONS: AUAL serves as an effective intervention to reduce 24‑hour postoperative blood loss in patients undergoing cesarean section for placenta previa. Although it was associated with more severe postoperative abdominal pain, it does not compromise key clinical recovery outcomes.