INTRAMYOMETRIAL INJECTION OF VASOPRESSIN TO MINIMIZE BLEEDING DURING CESAREAN HYSTERECTOMY OF PLACENTA ACRETA SPECTRUM

Abstract

To evaluate the efficacy and safety of intramyometrial vasopressin injection in reducing intraoperative blood loss and transfusion requirements during cesarean hysterectomy for placenta accreta spectrum (PAS).

Methodology:
A single-center, prospective, randomized controlled trial was conducted at MCH PIMS from January to March 2025. Sixty antenatal women diagnosed with major PAS by ultrasound were randomly allocated into two groups: Group A (n=30) received intramyometrial vasopressin (20 U in 19 mL saline), and Group B (n=30) received an equivalent volume of normal saline following delivery and cord clamping. Standardized surgical teams and monitoring protocols were employed. Estimated blood loss (EBL) was measured using suction volumes and mop weight differentials. Perioperative outcomes, including hemoglobin change, transfusion requirement, and operative duration, were compared using independent t-tests, chi-square, or Fisher’s exact tests.

Results:
Mean EBL was significantly lower in the vasopressin group (0.84 ± 0.20 L) compared to controls (1.81 ± 0.48 L; p<0.001). Fewer patients in the vasopressin group experienced blood loss >1 L (60.0% vs 86.7%; p=0.020). The mean number of transfused blood products was lower in the vasopressin group (0.30 ± 0.60 vs 0.97 ± 1.23; p=0.023). Post-operative hemoglobin was higher in the vasopressin group, though not statistically significant (p=0.073). Operative time did not differ significantly (p=0.342). Emergency procedures were associated with greater EBL (p=0.003).

Conclusion:
Intramyometrial vasopressin significantly reduces intraoperative blood loss and transfusion needs in PAS-related cesarean hysterectomy without prolonging operative time, supporting its use as an effective hemostatic adjunct.