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Lu R, Chu R, Wang Q, Xu Y, Zhao Y, Tao G, Li Q, Ma Y. Role of Abdominal Aortic Balloon Placement in Planned Conservative Management of Placenta Previa With Placenta Increta or Percreta. Front Med (Lausanne) 2022; 8:767748. [PMID: 34970561 PMCID: PMC8712569 DOI: 10.3389/fmed.2021.767748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: We investigated the role of balloon placement in the abdominal aorta (BPAA) in planned conservative management of placenta previa with placenta increta or percreta and the effects of BPAA on perinatal adverse maternal events. Methods: This retrospective case-control study included women with placenta previa (increta or percreta), who underwent pregnancy termination at the Qilu Hospital of Shandong University between January 2016 and June 2019. Patients were categorized into the BPAA and non-BPAA groups based on the BPAA placement before delivery. The Chi-square and non-parametric rank-sum tests were used for the intergroup comparison of patient characteristics. The propensity score matching algorithm was used to minimize the intergroup differences in clinical characteristics. Logistic regression analysis was used to identify the factors associated with a high risk of adverse pregnancy outcomes. The area under the receiver operating characteristic curve [area under the curve (AUC)] was used to evaluate the classification of the selected high-risk factors. Results: The study included 260 patients, and 104 patients were identified after propensity score matching. In the post-matched cohort, intraoperative blood loss was significantly lower in the BPAA than in the non-BPAA group (median 1,000 vs. 2,250 ml, P < 0.001). Intraoperative B-Lynch suture was performed in fewer patients in the BPAA (15.4 vs. 34.6%, P = 0.024) than in the non-BPAA group. The packed red blood cell (PRBC) transfusion rate was lower in the BPAA group (median 4 vs. 8 units, P < 0.001). Overall, 46 (45.1%) patients developed adverse maternal events; however, the rate of adverse maternal events was lower in the BPAA group (19.6 vs. 80.4%, P < 0.001). No ligation of the ascending branch of the uterine artery (P = 0.034), no BPAA (P < 0.001), intraplacental vascular lacunae (P = 0.046), and cervical hypervascularity (P = 0.001) were associated with a high risk of adverse perinatal maternal events. The AUC of the high-risk factors was 0.89 in the post-matched and 0.76 in the pre-matched cohorts. Conclusion: Planned conservative management using BPAA significantly minimized the intraoperative blood loss, the need for a B-Lynch suture, and PRBC transfusion in patients with severe placenta accreta spectrum and placenta previa.
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Affiliation(s)
- Ruihui Lu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiannan Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yintao Xu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ying Zhao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guowei Tao
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Qi Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuyan Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
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Mishra A, Dash S, Rath SK. B-Lynch Resulting in Total Uterine Necrosis Leading to Obstetric Hysterectomy. J Obstet Gynaecol India 2019; 69:4-6. [PMID: 30956480 DOI: 10.1007/s13224-017-1068-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Abhipsa Mishra
- Department of Obstetrics and Gynaecology, KIMS Hospital, Bhubaneswar, Odisha India
| | - Sudarshan Dash
- Department of Obstetrics and Gynaecology, KIMS Hospital, Bhubaneswar, Odisha India
| | - Sudhansu Kumar Rath
- Department of Obstetrics and Gynaecology, KIMS Hospital, Bhubaneswar, Odisha India
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Successful term delivery after Khairy’s modified B-lynch suture technique: First case report. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zhang ZW, Liu CY, Yu N, Guo W. Removable uterine compression sutures for postpartum haemorrhage. BJOG 2014; 122:429-33. [PMID: 25175111 DOI: 10.1111/1471-0528.13025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- ZW Zhang
- Department of Obstetrics; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan China
| | - CY Liu
- Department of Obstetrics; Jinan Maternity and Child Care Hospital; Jinan China
| | - N Yu
- Department of Obstetrics; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan China
| | - W Guo
- Department of Obstetrics; Shandong Provincial Qianfoshan Hospital; Shandong University; Jinan China
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Begum J, Pallave P, Ghose S. B-lynch: a technique for uterine conservation or deformation? A case report with literature review. J Clin Diagn Res 2014; 8:OD01-3. [PMID: 24959485 DOI: 10.7860/jcdr/2014/8139.4284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 01/31/2014] [Indexed: 11/24/2022]
Abstract
Postpartum haemorrhage is a leading cause of global maternal mortality and morbidity, accounting for 25-30% of all maternal deaths, and 75-90% of these casualties result from uterine atony. Uterine compressive sutures are a well established measure for control of haemorrhage following atonic postpartum haemorrhage, when medical and nonmedical interventions fail. Here, we are reporting a case of secondary infertility in a 24-year-old lady who had undergone an elective caesarean section for central placenta previa in her first pregnancy. She had massive postpartum haemorrhage, for which B-Lynch suture and vessel ligation were done. Subsequently, she failed to conceive for 4 years. This was because of severe pelvic adhesions and uterine deformation which were found intraoperatively, as a consequence of previous use of B-Lynch suture. As no definitive treatment could be offered to her, we suggested her to go for adoption.
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Affiliation(s)
- Jasmina Begum
- Assistant Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
| | - P Pallave
- Associate Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
| | - Seetesh Ghose
- Professor, Department of Obstetrics and Gynaecology, Mahatama Gandhi Medical College and Research Institute , Puducherry, India
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Later reproductive health after B-Lynch sutures: a follow-up study after 10 years' clinical use of the B-Lynch suture. Fertil Steril 2014; 101:1194-9. [DOI: 10.1016/j.fertnstert.2014.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/23/2013] [Accepted: 01/10/2014] [Indexed: 11/18/2022]
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Alouini S. Hysteroscopy after hemostatic sutures for postpartum hemorrhage. Taiwan J Obstet Gynecol 2014; 52:616. [PMID: 24411059 DOI: 10.1016/j.tjog.2013.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Souhail Alouini
- Department of Obstetrics and Gynecologic Surgery, Centre Hospitalier Régional d'Orléans, 45000, France.
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