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Risk Factors for Intrauterine Tamponade Failure in Postpartum Hemorrhage. Obstet Gynecol 2022; 140:439-446. [PMID: 35926196 DOI: 10.1097/aog.0000000000004888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/26/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To identify factors associated with intrauterine tamponade failure after vaginal or cesarean delivery. METHODS This was a nationwide population-based cohort study that used data from the French Programme de Médicalisation des Systèmes d'Information. This study compared the failure and effectiveness of intrauterine tamponade among all women who received the procedure in France from January 1, 2019, to December 31, 2019. Failure was defined as the use of a second-line method (uterine artery embolization, conservative or radical surgery, or death) within 7 days of intrauterine tamponade. Factors associated with intrauterine tamponade failure were identified by univariate analyses and tested using multivariate generalized logistic regression models (with a random intercept on institution) to obtain adjusted odds ratio (aOR) and 95% CI statistics. RESULTS A total of 39,193 patients presented with postpartum hemorrhage in 474 French maternity wards. Of these patients, 1,761 (4.5%) received intrauterine tamponade for persistent bleeding. The effectiveness rate of intrauterine tamponade was 88.9%. For 195 women (11.1%), a second-line method was indicated. Patients for whom intrauterine tamponade failed had a higher maternal age, a lower mean gestational age, and more frequent instances of placental abnormalities, preeclampsia, cesarean birth, and uterine rupture. The multivariate analysis revealed that cesarean birth (aOR 4.2; 95% CI 2.9-6.0), preeclampsia (aOR 2.3; 95% CI 1.3-4.0), and uterine rupture (aOR 14.1; 95% CI 2.4-83.0) were independently associated with intrauterine tamponade failure. CONCLUSION Cesarean delivery, preeclampsia, and uterine rupture are associated with intrauterine tamponade failure in the management of postpartum hemorrhage.
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Puente-Luján MJ, Andrés-Orós MP, Álvarez-Sarrado L, Agustín-Oliva A, González-Ballano I, Rodríguez-Solanilla B, Castán-Mateo S. Bakri Balloon: an easy, useful and effective option for the treatment of postpartum haemorrhage. J OBSTET GYNAECOL 2022; 42:1788-1792. [PMID: 35291903 DOI: 10.1080/01443615.2022.2039903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report our postpartum haemorrhage protocol focussing on the use of Bakri Balloon, describing its placement and affixing method, effectiveness rates, risk factors that might contribute to Bakri Balloon's failure and complications associated. We designed a retrospective study including 147 cases where a Bakri Balloon was necessary to control the postpartum uterine bleeding to assess the efficacy and to determine which clinical, obstetric or delivery variables could be associated with successful treatment. Failed treatment was defined when surgery or any other technique was needed after a Bakri Balloon placement in order to control uterine bleeding. For statistical analysis, we developed a descriptive analysis and a univariate logistic regression study.IMPACT STATEMENTWhat is already known on this subject? Postpartum haemorrhage is one of the most severe situations in the immediate postpartum period entailing a major cause of maternal morbimortality if an accurate and quick intervention is not carried out.What do the results of this study add? The use of Bakri Balloon was effective in 94.6% of patients. No statistically significant differences were found in the success rates according to obstetric or delivery characteristics. No major complications occurred due to the placement of a Bakri Balloon. In the failure group, blood loss was significantly higher and all required blood products transfusion.What are the implications of these findings for clinical practice and/or further research? Bakri Balloon is an easy-to-use device that provides an effective therapeutic alternative to more aggressive techniques in postpartum haemorrhages when medical treatment fails. Obstetrics or delivery characteristics should not entail a contraindication in its use. A continuous training system based on an agreed protocol is recommended in order to guarantee the best care possible.
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Affiliation(s)
| | | | | | - Andrea Agustín-Oliva
- Department of Obstetrics, Miguel Servet Maternal University Hospital, Zaragoza, Spain
| | | | | | - Sergio Castán-Mateo
- Department of Obstetrics, Miguel Servet Maternal University Hospital, Zaragoza, Spain
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The impact of a multilevel approach to reduce emergency hysterectomy for postpartum haemorrhage: insights from a tertiary referral centre in Northern Italy. Eur J Obstet Gynecol Reprod Biol 2022; 271:152-157. [DOI: 10.1016/j.ejogrb.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/13/2022]
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Zhu L, Lu J, Huang W, Zhao J, Li M, Zhuang H, Li Y, Liu H, Du L. A modified suture technique for the treatment of patients with pernicious placenta previa and placenta accreta spectrum: a case series. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1140. [PMID: 34430581 PMCID: PMC8350683 DOI: 10.21037/atm-21-2318] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/24/2021] [Indexed: 11/06/2022]
Abstract
Background Pernicious placenta previa complicated by placenta accreta spectrum (PAS) often leads to hysterectomy or even maternal death due to massive bleeding. In recent years, the application of balloons has received increasing attention. It is easier to use and has reasonably good effect. However, for some patients, especially those who still have some placental residue, there might still be active bleeding. To solve this problem, we propose a method of pressure sutures around the balloon to provide a better hemostasis effect. Methods An observational study was conducted on patients with pernicious placenta previa and PAS at the Beijing Chaoyang Hospital, Beijing, China, between January 2018 and January 2021. During surgery, an intrauterine balloon was used to compress the hemorrhage site, and two or more absorbable sutures were placed around the uterus to apply strong pressure on the balloon. This method is an updated modification of the Lu-suture which uses a Foley catheter balloon and only one suture. The main improvements include choosing different kinds of balloons depending on various conditions and the addition of a suture below the balloon to provide much stronger pressure and prevent the balloon slipping out through the dilated cervix. Results A total of 10 women underwent the procedure. The mean estimated intraoperative blood loss was 1,190±548 mL. Post-surgery, the blood loss was less than 200 mL in all patients. The mean blood transfusion [packed red blood cells (pRBC)] required was 2.2±2.6 units. The mean hemostatic time was 8.1±3.4 minutes. Conclusions The modified suture technique provided an easy, cheap, and efficient surgical choice for patients with pernicious placenta previa and PAS.
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Affiliation(s)
- Lei Zhu
- Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Junli Lu
- Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenyang Huang
- Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Zhao
- Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Menghui Li
- Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Huiyu Zhuang
- Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yanfang Li
- Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hao Liu
- Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lingyun Du
- Department of Obstetrics, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing, China
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Arakaki T, Matsuoka R, Takita H, Oba T, Nakamura M, Sekizawa A. The routine use of prophylactic Bakri balloon tamponade contributes to blood loss control in major placenta previa. Int J Gynaecol Obstet 2021; 154:508-514. [PMID: 33421119 DOI: 10.1002/ijgo.13589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/19/2020] [Accepted: 01/07/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To verify the blood loss control effect of routine prophylactic Bakri balloon tamponade on major and minor placenta previa (PP). METHODS We conducted a retrospective cohort study of all singleton pregnancies that involved cesarean section (CS) for PP at our hospital. All participants were divided into Bakri balloon (underwent routine prophylactic use just after placenta removal) and non-balloon groups, and into major and minor PP groups. Clinical outcomes in major and minor PP were compared between balloon and non-balloon groups. RESULTS The balloon and non-balloon groups contained 74 and 89 patients, respectively. There were 41 and 33 (balloon group) and 48 and 41 (non-balloon group) major and minor PP cases, respectively. Intraoperative and perioperative blood losses of major PP were significantly lower in the balloon group than the non-balloon group (1045 ml versus 1553 ml, P = 0.016; and 1189 ml versus 1810 ml, P = 0.006, respectively). The frequency of massive postpartum hemorrhage (>500 ml) with major PP was lower in the balloon group than in the non-balloon group (2.4% versus 16.7%, P = 0.027), but with no significant difference with minor PP. CONCLUSION Routine prophylactic use of Bakri balloon tamponade during and after CS is effective in controlling blood loss in major PP.
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Affiliation(s)
- Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Ryu Matsuoka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroko Takita
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tomohiro Oba
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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Chung P, Cheer K, Malacova E, Okano S, Rudra T. Obstetric outcomes in major vs minor placenta praevia: A retrospective cohort study. Aust N Z J Obstet Gynaecol 2020; 60:896-903. [PMID: 32729130 DOI: 10.1111/ajo.13218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Placenta praevia (PP) is a rare obstetric condition associated with significant maternal and perinatal morbidity. Traditionally, the degree of PP has been classified into minor and major; however, there are very few robust studies that compare the maternal outcomes of these types of PP. AIMS To identify any significant differences in obstetric outcomes between major and minor PP, including antepartum, intraoperative and postpartum complications. MATERIALS AND METHODS A retrospective cohort study was conducted at the Royal Brisbane & Women's Hospital between 2009 and 2018; all women were diagnosed with PP. RESULTS Of the total of 368 women recruited, over half of the participants were diagnosed with major PP (57%), while the remaining had minor PP. Women with major PP, compared to women with minor PP, had an increased risk of antepartum haemorrhage (odds ratio (OR) 2.77, P < 0.001), delivery at an earlier gestational age (36.1 vs 37.4 weeks), general anaesthesia (OR 3.25, P < 0.001), greater proportion of emergency lower segment (51% vs 40%) and classical caesarean (7.7% vs 3.8%), increased number of uterotonics (incidence rate ratio (IRR) 1.17, P < 0.031), greater blood loss (IRR 1.32, P < 0.001) and higher frequency of blood transfusion (IRR 2.00, P < 0.027), and longer postpartum hospital stay (IRR 1.26, P < 0.001). Hysterectomy was performed for three women with major PP, compared to one with minor PP. CONCLUSIONS The degree of PP significantly impacts obstetric outcomes, with major PP associated with worse maternal morbidity antenatally, intraoperatively and postpartum. Therefore, to optimise patient care, this study emphasises the importance of identifying and distinguishing between different types of PP.
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Affiliation(s)
- Philip Chung
- Department of Obstetrics and Gynaecology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Kenny Cheer
- Department of Obstetrics and Gynaecology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Eva Malacova
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Satomi Okano
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Thangeswaran Rudra
- Department of Obstetrics and Gynaecology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
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Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, Suarez-Rebling D, Eckardt M, Theron G, Burke TF. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 222:293.e1-293.e52. [PMID: 31917139 DOI: 10.1016/j.ajog.2019.11.1287] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the efficacy, effectiveness, and safety of uterine balloon tamponade for treating postpartum hemorrhage. STUDY DESIGN We searched electronic databases (from their inception to August 2019) and bibliographies. We included randomized controlled trials, nonrandomized studies, and case series that reported on the efficacy, effectiveness, and/or safety of uterine balloon tamponade in women with postpartum hemorrhage. The primary outcome was the success rate of uterine balloon tamponade for treating postpartum hemorrhage (number of uterine balloon tamponade success cases/total number of women treated with uterine balloon tamponade). For meta-analyses, we calculated pooled success rate for all studies, and relative risk with 95% confidence intervals for studies that included a comparative arm. RESULTS Ninety-one studies, including 4729 women, met inclusion criteria (6 randomized trials, 1 cluster randomized trial, 15 nonrandomized studies, and 69 case series). The overall pooled uterine balloon tamponade success rate was 85.9% (95% confidence interval, 83.9-87.9%). The highest success rates corresponded to uterine atony (87.1%) and placenta previa (86.8%), and the lowest to placenta accreta spectrum (66.7%) and retained products of conception (76.8%). The uterine balloon tamponade success rate was lower in cesarean deliveries (81.7%) than in vaginal deliveries (87.0%). A meta-analysis of 2 randomized trials that compared uterine balloon tamponade vs no uterine balloon tamponade in postpartum hemorrhage due to uterine atony after vaginal delivery showed no significant differences between the study groups in the risk of surgical interventions or maternal death (relative risk, 0.59; 95% confidence interval, 0.02-16.69). A meta-analysis of 2 nonrandomized before-and-after studies showed that introduction of uterine balloon tamponade in protocols for managing severe postpartum hemorrhage significantly decreased the use of arterial embolization (relative risk, 0.29; 95% confidence interval, 0.14-0.63). A nonrandomized cluster study reported that use of invasive procedures was significantly lower in the perinatal network that routinely used uterine balloon tamponade than that which did not use uterine balloon tamponade (3.0/1000 vs 5.1/1000; P < .01). A cluster randomized trial reported that the frequency of postpartum hemorrhage-related invasive procedures and/or maternal death was significantly higher after uterine balloon tamponade introduction than before uterine balloon tamponade introduction (11.6/10,000 vs 6.7/10,000; P = .04). Overall, the frequency of complications attributed to uterine balloon tamponade use was low (≤6.5%). CONCLUSION Uterine balloon tamponade has a high success rate for treating severe postpartum hemorrhage and appears to be safe. The evidence on uterine balloon tamponade efficacy and effectiveness from randomized and nonrandomized studies is conflicting, with experimental studies suggesting no beneficial effect, in contrast with observational studies. Further research is needed to determine the most effective programmatic and healthcare delivery strategies on uterine balloon tamponade introduction and use.
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Affiliation(s)
- Sebastian Suarez
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan
| | - Anderson Borovac-Pinheiro
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas (SP), Brazil
| | - Daniela Suarez-Rebling
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Melody Eckardt
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Thomas F Burke
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Said Ali A, Faraag E, Mohammed M, Elmarghany Z, Helaly M, Gadallah A, Taymour MA, Ahmad Y, Ibrahim Eissa A, Ibrahim Ogila A, Ali MK, Abou-Taleb HA, Samy A, Abbas AM. The safety and effectiveness of Bakri balloon in the management of postpartum hemorrhage: a systematic review. J Matern Fetal Neonatal Med 2019; 34:300-307. [PMID: 30957590 DOI: 10.1080/14767058.2019.1605349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Postpartum hemorrhage (PPH) is a direct cause of maternal death all over the world. A Bakri balloon is recommended by American College of Obstetricians and Gynecologists (ACOG) and World Health Organization (WHO) as a treatment line for PPH unresponsive to uterotonics. We carried out a systematic review to assess the safety and effectiveness of Bakri balloon in the management of PPH.Methods: We searched PubMed, SCOPUS, central Cochrane, and Web of Science, from 2001 to 2018 for randomized controlled trials (RCTs) and observational studies to assess the safety and effectiveness of Bakri balloon on refractory PPH.Results: Twenty-eight articles were included for analysis. The primary indication for the use of a Bakri balloon tamponade was PPH. Only 67.9% (19/28) quantified the estimate blood loss necessary to use the balloon. Uterine atony was the underlying cause of PPH in 75% (21/28) of studies. Most of the studies on Bakri balloon are followed by vaginal birth (3/4). Bakri balloon displacement from the uterine cavity was reported by five publications, with the overall rate being 9% (95% CI: 5-15%). Hysterectomy was necessary for 1% (95% CI: 0-8%) of the women who required the balloon.Conclusions: Bakri balloon seems to be a less effective tool for management of PPH either after vaginal or cesarean delivery.
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Affiliation(s)
| | - Esraa Faraag
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Mariam Helaly
- Faculty of Pharmacy, Cairo University Clinical Program, Cairo, Egypt
| | | | - Mohammad A Taymour
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yahia Ahmad
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Ibrahim Eissa
- Department of Obstetrics and Gynaecology, Al Hammadi Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Asmaa Ibrahim Ogila
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed K Ali
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hisham A Abou-Taleb
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Samy
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Soyama H, Miyamoto M, Ishibashi H, Nakatsuka M, Kawauchi H, Sakamoto T, Matuura H, Kuwahara M, Takasaki K, Iwahashi H, Kato K, Yoshida M, Takano M, Sasa H, Furuya K. Analysis of prophylactic Bakri balloon tamponade failure in patients with placenta previa. Taiwan J Obstet Gynecol 2019; 58:159-163. [DOI: 10.1016/j.tjog.2018.11.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/25/2022] Open
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Jauniaux E, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL, Dornan S, Jurkovic D, Kayem G, Kingdom J, Silver R, Sentilhes L. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG 2018; 126:e1-e48. [PMID: 30260097 DOI: 10.1111/1471-0528.15306] [Citation(s) in RCA: 223] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Guo Y, Hua R, Bian S, Xie X, Ma J, Cai Y, Sooranna SR, Cheng W. Intrauterine Bakri Balloon and Vaginal Tamponade Combined with Abdominal Compression for the Management of Postpartum Hemorrhage. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:561-565. [DOI: 10.1016/j.jogc.2017.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/19/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
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Mohamed MA, Mohammed AH. Parallel vertical compression sutures to control bleeding in cases of placenta previa and accreta. J Matern Fetal Neonatal Med 2017; 32:641-645. [DOI: 10.1080/14767058.2017.1387895] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Magdy A. Mohamed
- Obstetrics and Gynecology Department, Sohag Faculty of Medicine, Sohag University, Sohag Governorate, Egypt
| | - Ahmed H. Mohammed
- Obstetrics and Gynecology Department, Sohag Faculty of Medicine, Sohag University, Sohag Governorate, Egypt
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Zeng C, Yang M, Ding Y, Yu L, Deng W, Hu Y, Gong X. Preoperative infrarenal abdominal aorta balloon catheter occlusion combined with Bakri tamponade reduced maternal morbidity of placenta increta/percreta. Medicine (Baltimore) 2017; 96:e8114. [PMID: 28930860 PMCID: PMC5617727 DOI: 10.1097/md.0000000000008114] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Placenta increta/percreta is an increasingly common and life-threatening obstetric complication. It poses a management challenge to clinicians. The present study aimed to evaluate efficacy and safety of preoperative placement of infrarenal abdominal aorta balloon catheter (IAABC) alone or combined with Bakri tamponade for the management of cases with placenta increta/percreta. METHODS We retrospectively analyzed all cases with placenta increta/percreta at a tertiary referral teaching hospital in China between the year 2014 and 2017. Statistical analysis considered the individual subgroups: IAABC placed group and control group (without IAABC), and compared their maternal-fetal outcomes. RESULTS The study covered 86 cases with placenta increta. For cases in the IAABC placed group (n = 48), significant reductions were noted in maternal morbidity including estimated blood loss (EBL), EBL ≥ 2000 mL, blood products transfusions, postpartum hemorrhage, operative time, intensive care unit admission, and postoperative days (P < .05 for all). The overall rate of hysterectomy was much lower (4.2%vs 23.7%, P = .018), compared with those in the control group (n = 38). Furthermore, in the IAABC placed group, hysterectomy was avoided in a further 17 cases combined with Bakri tamponade. In the control group, 10 cases were successful in preserving uterus by Bakri tamponade. Four cases failed and needed reoperation (3 uterine arterial embolism, 1 hysterectomy). There were no differences in fetal outcomes between the 2 groups. Eighteen cases were diagnosed with placenta percreta. Almost all the cases (17/18) inevitably underwent caesarean hysterectomy. Only 1 case was treated with a combination of IAABC and Bakri tamponade, and successfully reserved uterus. No differences were observed in any other outcomes, except for a significant less mean operative time (P = .017) in cases with IAABC placed (n = 10), compared with those without IAABC (n = 8). Only 1 case had a femoral artery thrombosis directly related to IAABC placement and recovered after conservative treatment. There was no maternal or neonatal death in this study. CONCLUSION Prophylactic insertion of IAABC alone or combined with Bakri tamponade should be safe and effective in controlling intraoperative bleeding due to placenta increta, thus hysterectomy could be avoided. It seems to be less beneficial to women with placenta percreta. Bakri tamponade can be a good choice in the management of placenta increta/percreta before more aggressive surgeries.
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Soyama H, Miyamoto M, Sasa H, Ishibashi H, Yoshida M, Nakatsuka M, Takano M, Furuya K. Effect of routine rapid insertion of Bakri balloon tamponade on reducing hemorrhage from placenta previa during and after cesarean section. Arch Gynecol Obstet 2017. [DOI: 10.1007/s00404-017-4446-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Tahaoglu AE, Balsak D, Erdogdu E, Bakır MS, Aksin S, Bala M, Togrul C, Yalınkaya A. Bakri balloon placement effectively treats uterine atony and placenta previa. BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2017.1298467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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16
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Darwish AM, Abdallah MM, Shaaban OM, Ali MK, Khalaf M, Sabra AMA. Bakri balloon versus condom-loaded Foley’s catheter for treatment of atonic postpartum hemorrhage secondary to vaginal delivery: a randomized controlled trial. J Matern Fetal Neonatal Med 2017; 31:747-753. [PMID: 28274173 DOI: 10.1080/14767058.2017.1297407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Atef M. Darwish
- Woman’s Health University Hospital, Assiut University, Assiut, Egypt
| | | | - Omar M. Shaaban
- Woman’s Health University Hospital, Assiut University, Assiut, Egypt
| | - Mohammed K. Ali
- Woman’s Health University Hospital, Assiut University, Assiut, Egypt
| | - Mohamed Khalaf
- Woman’s Health University Hospital, Assiut University, Assiut, Egypt
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17
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Maher MA, Abdelaziz A. Comparison between two management protocols for postpartum hemorrhage during cesarean section in placenta previa: Balloon protocol versus non-balloon protocol. J Obstet Gynaecol Res 2016; 43:447-455. [PMID: 27987342 DOI: 10.1111/jog.13227] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/28/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mohammad Ahmed Maher
- Department of Obstetrics and Gynecology, Faculty of Medicine; Menoufia University; Shebin-Elkom Egypt
- Al-Hayat National Hospital; Khamis-Mushait Saudi Arabia
| | - Ahmed Abdelaziz
- Department of Obstetrics and Gynecology, Faculty of Medicine; Ain-shams University; Cairo Egypt
- Armed Forces Hospital North-West Region; Tabouk Saudi Arabia
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18
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The fertility sparing management of postpartum hemorrhage: A series of 47 cases of Bakri balloon tamponade. Taiwan J Obstet Gynecol 2016; 54:232-5. [PMID: 26166332 DOI: 10.1016/j.tjog.2014.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the success rate of Bakri balloon tamponade (BBT) for managing postpartum hemorrhage (PPH), intractable to conservative medical treatment, as a fertility sparing intervention. MATERIALS AND METHODS We evaluated 47 women treated with BBT who had severe postpartum hemorrhage and uncontrollable bleeding due to failed treatment with uterotonic agents. The main outcome measure was successful management and preservation of the uterus. RESULTS Forty-seven women were identified for BBT treatment due to severe PPH. BBT was used to successfully manage hemorrhage in 43 patients, and there was no need for hysterectomy. Four patients required an additional surgical procedure. Of the four failures, a subtotal hysterectomy was performed in two patients, and the other two patients underwent a total hysterectomy. The overall success rate was 91.4%, which was comparable to rates reported earlier. The main cause of PPH was uterine atony (43%). CONCLUSION Uterine preservation is an important issue when managing PPH. BBT is an effective, easy to use, and safe procedure for massive PPH that can minimize recourse to hysterectomy after failed medical treatment.
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Nagai S, Kobayashi H, Nagata T, Hiwatashi S, Kawamura T, Yokomine D, Orita Y, Oki T, Yoshinaga M, Douchi T. Clinical Usefulness of Bakri Balloon Tamponade in the Treatment of Massive Postpartum Uterine Hemorrhage. Kurume Med J 2016; 62:17-21. [PMID: 26935443 DOI: 10.2739/kurumemedj.ms65004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intrauterine globe-shaped metreurynter tamponade has been used for some time to treat massive postpartum hemorrhage (PPH). More recently, the Bakri balloon has come into use to treat PPH. It is made of silicon, possesses a drainage lumen, and has a sausage-like spindle shape. The aim of the present study was to investigate the clinical usefulness of Bakri balloon tamponade for massive PPH. Subjects in the present study comprised 5 patients with uterine atony, 3 with placenta previa, and 2 with low-lying placenta. All patients exhibited massive PPH and resistance to conventional hemostatic managements. Bakri balloon tamponade was appliedto these 10 patients. The mean amounts of uterine bleeding (average ± SD) before and after Bakri insertion were2,732 ± 1,397 mL and 380 ± 376 mL, respectively. The median (third-first quartile ranges) volume of salineinflating the balloon was 200 mL (300-150 mL). The median (third-first quartile ranges) indwelling duration of Bakri balloon was 24 hours (24-11 hrs). The overall success rate of Bakri balloon tamponade was 90% (9/10).There were no cases of slipping out or complications regarding balloon placement. Our findings suggest that Bakri balloon tamponade may be applied to the treatment of massive PPH in uterine atony and placenta previa.The Bakri balloon appears to have the following merits: (1) easy insertion into the uterine cavity and low rate of slipping out, (2) proper conformability to the hemorrhagic area due to its spindle shape, (3) ability to monitor blood loss through the drainage lumen even after insertion.
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Affiliation(s)
- Sayori Nagai
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University
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20
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Matsubara S, Baba Y, Morisawa H, Takahashi H, Lefor A. Maintaining the position of a Bakri balloon after caesarean section for placenta previa using an abdominal traction stitch. Eur J Obstet Gynecol Reprod Biol 2016; 198:177-178. [DOI: 10.1016/j.ejogrb.2016.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/30/2015] [Accepted: 01/20/2016] [Indexed: 11/24/2022]
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21
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Abstract
Bakri balloons are minimally invasive devices placed in the uterus and inflated with saline to apply extrinsic pressure to stop postpartum hemorrhage. Sonography is an ideal imaging modality to confirm position of a Bakri balloon because it is quick and precise in locating the device, does not use ionizing radiation, and is inexpensive. This case report describes the sonographic documentation and management of a malpositioned Bakri balloon.
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22
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Martin E, Legendre G, Bouet PE, Cheve MT, Multon O, Sentilhes L. Maternal outcomes after uterine balloon tamponade for postpartum hemorrhage. Acta Obstet Gynecol Scand 2015; 94:399-404. [DOI: 10.1111/aogs.12591] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Emmanuelle Martin
- Department of Obstetrics and Gynecology; Angers University Hospital; Angers France
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology; Angers University Hospital; Angers France
| | | | - Marie-Therese Cheve
- Department of Obstetrics and Gynecology; Le Mans General Hospital; Le Mans France
| | - Olivier Multon
- Department of Obstetrics and Gynecology; Atlantic Polyclinic; Saint-Herblain France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology; Angers University Hospital; Angers France
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23
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Cheng XH, Chen WX, Zeng W. Hemabate injection at different sites in cesarean section: Gastrointestinal adverse reactions and nursing measures. Shijie Huaren Xiaohua Zazhi 2015; 23:483-485. [DOI: 10.11569/wcjd.v23.i3.483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To observe the gastrointestinal adverse reactions of Hemabate injection at different sites in cesarean section and discuss nursing measures.
METHODS: A retrospective analysis was performed of 120 women who received Hemabate injection at different sites (group A: intrauterine injection; group B: intramuscular injection into the deltoid muscle) in cesarean section between January 2011 and December 2012. Gastrointestinal adverse reactions and nursing measures were analyzed.
RESULTS: The incidences of bleeding at 2 and 24 h postpartum showed no significant difference between the two groups (P > 0.05). The incidence of gastrointestinal adverse reactions was significantly lower in group A than in group B (15.7% vs 42.0%, P < 0.05).
CONCLUSION: Intrauterine injection of Hemabate is superior to intramuscular injection into the deltoid muscle with regard to lower incidence of gastrointestinal adverse reactions, although the incidences of postpartum bleeding are similar between the two groups.
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24
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Cervical inversion as a novel technique for postpartum hemorrhage management during cesarean delivery for placenta previa accreta/increta. Int J Gynaecol Obstet 2014; 128:122-5. [DOI: 10.1016/j.ijgo.2014.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 08/20/2014] [Accepted: 10/20/2014] [Indexed: 12/25/2022]
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25
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Uygur D, Altun Ensari T, Ozgu-Erdinc A, Dede H, Erkaya S, Danisman A. Successful use of BT-Cath® balloon tamponade in the management of postpartum haemorrhage due to placenta previa. Eur J Obstet Gynecol Reprod Biol 2014; 181:223-8. [DOI: 10.1016/j.ejogrb.2014.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/25/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
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26
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Alouini S, Bedouet L, Ramos A, Ceccaldi C, Evrard ML, Khadre K. [Bakri balloon tamponade for severe post-partum haemorrhage: efficiency and fertility outcomes]. ACTA ACUST UNITED AC 2014; 44:171-5. [PMID: 24975399 DOI: 10.1016/j.jgyn.2014.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/05/2014] [Accepted: 05/14/2014] [Indexed: 11/18/2022]
Abstract
AIM To evaluate efficiency of Bakri balloon tamponade (BB) to stop severe post-partum haemorrhage (PPH) and fertility outcomes. METHODS Retrospective study including all patients who underwent Bakri balloon tamponade for severe PPH between January 2009 and December 2013. The objectives were to stop PPH by BB and to evaluate the fertility after Bakri balloon tamponade. RESULTS Sixty-one women had a Bakri balloon inserted in utero for severe PPH. The PPH was stopped in 55 patients out of 61 (88%). The reasons of severe PPH were uterine atony in 44 cases (72%), placental retention in 10 cases, placenta praevia in 3 cases, and cervical or vaginal tears in 4 cases. In one third of cases, the pregnancy was complicated by diabetes, placenta praevia, hypertensive troubles. A cesarean section or an instrumental delivery was performed for one third of patients. The mean duration of the Bakri balloon insertion was of 7 hours [5-9] and the mean filling of the balloon was of 350 ml [205-450]. The mean blood loss was of 1600 [1200-2250]. Sixty-three percent of patients (n=38) received red blood cells transfusion. The BB was efficient after a vaginal delivery or after a caesarean section and in all cases of placenta praevia. In 6 cases, the BB was inefficient and uterine embolisation or a surgical procedure was performed to stop PPH. Nine women underwent a new pregnancy after the insertion of Bakri balloon for severe PPH and 3 delivered healthy newborns. CONCLUSION Bakri balloon tamponade is a minimally invasive intrauterine device efficient to stop severe post-partum haemorrhage. New pregnancies and deliveries are possible after tamponade by Bakri balloon.
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Affiliation(s)
- S Alouini
- Département de gynécologie-obstétrique, CHR d'Orléans, 1, Porte-Madeleine, 45000 Orléans, France.
| | - L Bedouet
- Département de gynécologie-obstétrique, CHR d'Orléans, 1, Porte-Madeleine, 45000 Orléans, France
| | - A Ramos
- Département de gynécologie-obstétrique, CHR d'Orléans, 1, Porte-Madeleine, 45000 Orléans, France
| | - C Ceccaldi
- Département de gynécologie-obstétrique, CHR d'Orléans, 1, Porte-Madeleine, 45000 Orléans, France
| | - M L Evrard
- Département de gynécologie-obstétrique, CHR d'Orléans, 1, Porte-Madeleine, 45000 Orléans, France
| | - K Khadre
- Département de radiologie interventionnelle, CHR Orléans-La Source, 45100, France
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Sahin S, Guzin K, Eroğlu M, Kayabasoglu F, Yaşartekin MS. Answer to: letter to the editor entitled "Uterus preservation as an alternative to an emergency hysterectomy for postpartum hemorrhage". Arch Gynecol Obstet 2014; 289:931-2. [PMID: 24659333 DOI: 10.1007/s00404-014-3209-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A new approach for the Bakri balloon for placenta previa. Eur J Obstet Gynecol Reprod Biol 2014; 182:262-3. [PMID: 24560217 DOI: 10.1016/j.ejogrb.2014.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/21/2014] [Indexed: 11/22/2022]
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Tanaka T, Makino S, Yorifuji T, Saito T, Koshiishi T, Tanaka S, Ota A, Takeda S. Vertical compression sutures for control of postpartum hemorrhage from a placenta previa in cesarean section — To evaluate the usefulness of this technique. HYPERTENSION RESEARCH IN PREGNANCY 2014. [DOI: 10.14390/jsshp.2.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Toshitaka Tanaka
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine
| | - Takashi Yorifuji
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine
| | - Tomomi Saito
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine
| | - Taro Koshiishi
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine
| | - Saori Tanaka
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine
| | - Atsuyuki Ota
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine
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