1
|
Malik A, Rehman FU, Shah KU, Naz SS, Qaisar S. Hemostatic strategies for uncontrolled bleeding: A comprehensive update. J Biomed Mater Res B Appl Biomater 2021; 109:1465-1477. [PMID: 33511753 DOI: 10.1002/jbm.b.34806] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022]
Abstract
Uncontrolled bleeding remains the leading cause of morbidity and mortality across the entire macrocosm. It refers to excessive loss of blood that occurs inside of body, due to unsuccessful platelet plug formation at the injury site. It is not only limited to the battlefield, but remains the second leading cause of death amongst the civilians, as a result of traumatic injury. Startlingly, there are no effective treatments currently available, to cater the issue of internal bleeding, even though early intervention is of utmost significance in minimizing the mortality rates associated with it. The fatal issue of uncontrolled bleeding is ineffectively being dealt with the use of pressure dressings, tourniquet, and surgical procedures. This is not a practical approach in combat arenas or in emergency situations, where the traumatic injury inflicted is deep inside the body, and cannot be addressed externally, by the application of topical dressings. This review focuses on the traditional hemostatic agents that are used to augment the process of hemostasis, such as mineral zeolites, chitosan based products, biologically active agents, anti-fibrinolytics, absorbable agents, and albumin and glutaraldehyde, as well as the micro- and nano-based hemostatic agents such as synthocytes, thromboerythrocytes, thrombosomes, and the synthetic platelets.
Collapse
Affiliation(s)
- Annum Malik
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan.,Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Fiza Ur Rehman
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan.,Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | | | - Syeda Sohaila Naz
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan
| | - Sara Qaisar
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan
| |
Collapse
|
2
|
Yu SCH, Cheng YKY, Tse WT, Sahota DS, Chung MY, Wong SSM, Chan OK, Leung TY. Perioperative prophylactic internal iliac artery balloon occlusion in the prevention of postpartum hemorrhage in placenta previa: a randomized controlled trial. Am J Obstet Gynecol 2020; 223:117.e1-117.e13. [PMID: 31978436 DOI: 10.1016/j.ajog.2020.01.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Placenta previa remains one of the major causes of massive postpartum hemorrhage and maternal mortality worldwide. OBJECTIVE To determine whether internal iliac artery balloon occlusion during cesarean delivery for placenta previa could reduce postpartum hemorrhage and other maternal complications. STUDY DESIGN This was a prospective randomized controlled trial conducted at a tertiary university obstetric unit in Hong Kong. Pregnant women who were diagnosed to have placenta previa at 34 weeks (defined as lower placenta edge within 2 cm from the internal os) and required cesarean delivery were invited to participate. Eligible pregnant women were randomized into internal iliac artery balloon occlusion (Occlusion) group or standard management (Control) group. Those randomized to the Occlusion group had internal iliac artery balloon catheter placement performed before cesarean delivery and then balloon inflation after delivery of the baby. The primary outcome was the reduction of postpartum hemorrhage in those with internal iliac artery balloon occlusion. Secondary outcome measures included hemoglobin drop after delivery; amount of blood product transfusion; incidence of hysterectomy; maternal complications including renal failure, ischemic liver, disseminated intravascular coagulation, and adult respiratory distress syndrome; length of stay in hospital; admission to intensive care unit; and maternal death. RESULTS Between May 2016 and September 2018, 40 women were randomized (20 in each group). Demographic and obstetric characteristics were similar between the 2 groups. In the Occlusion group, 3 women did not receive the scheduled procedure, as it was preceded by antepartum hemorrhage that required emergency cesarean delivery, and 1 woman had repeated scan at 36 weeks showing the placental edge was slightly more than 2 cm from the internal os. Intention-to-treat analysis found no significant differences between the Occlusion and the Control groups regarding to the median intraoperative blood loss (1451 [1024-2388] mL vs 1454 [888-2300] mL; P = .945), the median length of surgery (49 [30-62] min vs 37 [30-51] min; P = .204), or the need for blood transfusion during operation (57.9% vs 50.0%; P = .621). None of the patients had rebleeding after operation, complication related to internal iliac artery procedure, or any other maternal complications. Reanalyzing the data using on-treatment approach showed the same results. CONCLUSION The use of prophylactic internal iliac artery balloon occlusion in placenta previa patients undergoing cesarean delivery did not reduce postpartum hemorrhage or have any effect on maternal or neonatal morbidity.
Collapse
|
3
|
Alalfy M, Hussein E, Saber W, Elsharkawy M, Salama S, Lasheen Y, Elshafey D, Taher A, Farouk D, Eltaieb E, Elsirgany S, Hussein M, Fikry M, Hassan H, Sadek J, Alaa D, Torad H, Abdella R, Ali S, Yehia A, Lotfy R, Hanafy A, Hassan A. Alalfy modified cervical inversion technique as a tamponade in controlling PPH in placenta previa, a multicentric double blind randomized controlled trial. J Matern Fetal Neonatal Med 2019; 34:3162-3168. [PMID: 31630600 DOI: 10.1080/14767058.2019.1678140] [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: 10/25/2022]
Abstract
INTRODUCTION Postpartum hemorrhage that occurs frequently with placenta previa is one of the causes of maternal mortality in 14% in developing countries. OBJECTIVE To assess efficacy of cervical inversion as a tamponade in controlling bed of placenta in cases of placenta previa. PATIENTS AND METHOD A prospective randomized controlled study was conducted among a total of 240 pregnant women with placenta previa (120 subjected to Alalfy modified cervical inversion technique plus hemostatic sutures and 120 was not subjected cervical inversion and only was subjected to hemostatic sutures in Obstetrics and Gynecology Department at Suez Canal University hospital, Helwan University and Algezeerah hospital for a planned cesarean section). RESULTS The mean intraoperative blood loss, the intraoperative time, and the postoperative hemoglobin show a statistically significant difference between cases with placenta previa who were exposed to cervical inversion in comparison to cases that had no cervical inversion with a p-value <.001. CONCLUSION Modified cervical inversion (Alalfy technique) as a tamponade when added to hemostatic sutures to the placental bed is an easy, rapid, and efficient procedure that can decrease the amount of blood loss, time needed to stop bleeding per bed, total operative time, also it can decrease the need for blood transfusion.
Collapse
Affiliation(s)
- Mahmoud Alalfy
- Reproductive Health and Family Planning Department, National Research Centre, Giza, Egypt.,Department of Obstetrics and Gynecology, Algezeerah Hospital, Giza, Egypt
| | - Elham Hussein
- Obstetrics and Gynecology Department, Suez Canal University, Al Ismailia, Egypt
| | - Waled Saber
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Elsharkawy
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sameh Salama
- Reproductive Health and Family Planning Department, National Research Centre, Giza, Egypt.,Department of Obstetrics and Gynecology, Algezeerah Hospital, Giza, Egypt
| | - Yossra Lasheen
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Elshafey
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Taher
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Farouk
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - E Eltaieb
- Obstetrics and Gynecology Department, Ainshams Faculty of Medicine, Cairo, Egypt
| | - Sherif Elsirgany
- Reproductive Health and Family Planning Department, National Research Centre, Giza, Egypt.,Department of Obstetrics and Gynecology, Algezeerah Hospital, Giza, Egypt
| | - Mohamed Hussein
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Fikry
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hatem Hassan
- Reproductive Health and Family Planning Department, National Research Centre, Giza, Egypt.,Department of Obstetrics and Gynecology, Algezeerah Hospital, Giza, Egypt
| | - Jehan Sadek
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Alaa
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hesham Torad
- Urology Department, Kasralainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rana Abdella
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sief Ali
- Obstetrics and Gynecology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Amera Yehia
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Lotfy
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amal Hanafy
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hassan
- Obstetrics and Gynecology Department, Helwan Faculty of Medicine, Helwan University, Helwan, Egypt
| |
Collapse
|
4
|
Abstract
Uncontrolled surgical bleeding can have significant clinical and economic consequences including advanced medical expenses and impairment of the outcomes. Effective and safe local hemostatic agents based on a fluid active hemostatic matrix are reviewed in the article. The use of this agent is followed by reduced hospital-stay, number of redo interventions for bleeding, reduced time of surgery, intra- and postoperative complication rate and high economic efficiency.
Collapse
Affiliation(s)
- A B Zemlyanoy
- Pirogov National Medical and Surgical Center of Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
5
|
Mısırlıoğlu S, Türkgeldi E, Yağmur H, Urman B, Ata B. Use of a gelatin-thrombin hemostatic matrix in obstetrics and gynecological surgery. Turk J Obstet Gynecol 2018; 15:193-199. [PMID: 30202631 PMCID: PMC6127479 DOI: 10.4274/tjod.90217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/24/2018] [Indexed: 12/28/2022] Open
Abstract
Gelatin-thrombin matrix (GTM) is a hemostatic sealant consisting of bovine-derived gelatin matrix and human-derived thrombin, combining both mechanical and active mechanisms to achieve hemostasis. It was approved by the Food and Drug Administration in 1999. GTM has been used by several surgical specialties; however, it is a possibly an under-used tool in obstetrics and gynecology. A limited number of studies have been performed on its use during laparoscopic endometrioma excision and myomectomy. It may prove useful in endometrioma excision in reproductive aged women because it is likely to harm ovarian reserve less than electrocautery; however, this conclusion needs to be validated. The only study on GTM use in myomectomy included 50 women randomized into GTM and control groups, and showed decreased blood loss and shorter hospital stays in the GTM group. In gynecologic oncology, it was successfully used to reduce lymphocele cases in a cohort study. GTM has been used successfully in obstetrics in a handful of cases of uncontrolled bleeding from caesarean scar, placental site, ectopic pregnancy, rectovaginal hematoma, and venous plexus over the vaginal vault after emergency postpartum hysterectomy. Risk of viral transmission is a major concern about GTM, yet there are no reports on disease transmission with GTM use to date. Rare but serious adverse effects and complications have been reported such as fatal or near-fatal thromboembolism and small bowel obstruction. Although GTM is mostly a safe product, it is still not free of complications and risks. In conclusion, although routine use of GTM cannot be recommended due to concerns about its safety, cost, and availability, it may prove useful when conventional hemostatic methods such as suturing and electrocauterization fail or are not appropriate.
Collapse
Affiliation(s)
- Selim Mısırlıoğlu
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Engin Türkgeldi
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Hande Yağmur
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Bülent Urman
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Barış Ata
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| |
Collapse
|
6
|
Chung JPW, Leung TY. Uses of FloSeal © in obstetric hemorrhage: Case series and literature review. Taiwan J Obstet Gynecol 2018; 56:827-830. [PMID: 29241928 DOI: 10.1016/j.tjog.2017.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE FloSeal© has been shown to be an alternative and effective method of hemostasis. The current study examines the various uses of FloSeal© in obstetric hemorrhage and gives an overview of the literature. CASE REPORTS In this retrospective case review, a total of 11 cases with obstetric hemorrhage were reviewed throughout a period of one year. All but one case was successful in using FloSeal© in arresting the bleeding with hysterectomy avoided. FloSeal© can be considered when bleeding occurs locally at the placental bed, bladder base, adhesiolysis site, vaginal tears or at suture holes. CONCLUSION FloSeal© was a quick and effective alternative for hemostasis and should be considered when conventional hemostatic techniques fails or is impractical.
Collapse
Affiliation(s)
- Jacqueline Pui-Wah Chung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N. T., Hong Kong.
| | - Tak-Yeung Leung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N. T., Hong Kong
| |
Collapse
|
7
|
Gazzeri R, Galarza M, Morabito M, Alfieri A. Clinical Use and Hemostatic Application of Gelatin. POLYMER GELS 2018. [DOI: 10.1007/978-981-10-6083-0_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
8
|
Schjoldager BTBG, Mikkelsen E, Lykke MR, Præst J, Hvas AM, Heslet L, Secher NJ, Salvig JD, Uldbjerg N. Topical application of recombinant activated factor VII during cesarean delivery for placenta previa. Am J Obstet Gynecol 2017; 216:608.e1-608.e5. [PMID: 28219621 DOI: 10.1016/j.ajog.2017.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/27/2017] [Accepted: 02/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND During cesarean delivery in patients with placenta previa, hemorrhaging after removal of the placenta is often challenging. In this condition, the extraordinarily high concentration of tissue factor at the placenta site may constitute a principle of treatment as it activates coagulation very effectively. The presumption, however, is that tissue factor is bound to activated factor VII. OBJECTIVE We hypothesized that topical application of recombinant activated factor VII at the placenta site reduces bleeding without affecting intravascular coagulation. STUDY DESIGN We included 5 cases with planned cesarean delivery for placenta previa. After removal of the placenta, the surgeon applied a swab soaked in recombinant activated factor VII containing saline (1 mg in 246 mL) to the placenta site for 2 minutes; this treatment was repeated once if the bleeding did not decrease sufficiently. We documented the treatment on video recordings and measured blood loss. Furthermore, we determined hemoglobin concentration, platelet count, international normalized ratio, activated partial thrombin time, fibrinogen (functional), factor VII:clot, and thrombin generation in peripheral blood prior to and 15 minutes after removal of the placenta. We also tested these blood coagulation variables in 5 women with cesarean delivery planned for other reasons. Mann-Whitney test was used for unpaired data. RESULTS In all 5 cases, the uterotomy was closed under practically dry conditions and the median blood loss was 490 (range 300-800) mL. There were no adverse effects of recombinant activated factor VII and we did not measure factor VII to enter the circulation. Neither did we observe changes in thrombin generation, fibrinogen, activated partial thrombin time, international normalized ratio, and platelet count in the peripheral circulation (all P values >.20). CONCLUSION This study indicates that in patients with placenta previa, topical recombinant activated factor VII may diminish bleeding from the placenta site without initiation of systemic coagulation.
Collapse
Affiliation(s)
| | - Emmeli Mikkelsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Malene R Lykke
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Præst
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels J Secher
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jannie D Salvig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
9
|
Gibbins KJ, Einerson BD, Varner MW, Silver RM. Placenta previa and maternal hemorrhagic morbidity. J Matern Fetal Neonatal Med 2017; 31:494-499. [PMID: 28140723 DOI: 10.1080/14767058.2017.1289163] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Placenta previa is associated with maternal hemorrhage, but most literature focuses on morbidity in the setting of placenta accreta. We aim to characterize maternal morbidity associated with previa and to define risk factors for hemorrhage. METHODS This is a secondary cohort analysis of the NICHD Maternal-Fetal Medicine Units Network Cesarean Section Registry. This analysis included all women undergoing primary Cesarean delivery without placenta accreta. About 496 women with previa were compared with 24,201 women without previa. Primary outcome was composite maternal hemorrhagic morbidity. Non-hemorrhagic morbidities and risk factors for hemorrhage were also evaluated. RESULTS Maternal hemorrhagic morbidity was more common in women with previa (19 versus 7%, aRR 2.6, 95% CI 1.9-3.5). Atony requiring uterotonics (aRR 3.1, 95% CI 2.0-4.9), red blood cell transfusion (aRR 3.8, 95% CI 2.5-5.7), and hysterectomy (aRR 5.1, 95% CI 1.5-17.3) were also more common with previa. For women with previa, factors associated with maternal hemorrhage were pre-delivery anemia, thrombocytopenia, diabetes, magnesium use, and general anesthesia. CONCLUSION Placenta previa is an independent risk factor for maternal hemorrhagic morbidity. Some risk factors are modifiable, but many are intrinsic to the clinical scenario.
Collapse
Affiliation(s)
- Karen J Gibbins
- a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.,b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA
| | - Brett D Einerson
- a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.,b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA
| | - Michael W Varner
- a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.,b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA
| | - Robert M Silver
- a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.,b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA
| |
Collapse
|
10
|
Miller DT, Roque DM, Santin AD. Use of Monsel solution to treat obstetrical hemorrhage: a review and comparison to other topical hemostatic agents. Am J Obstet Gynecol 2015; 212:725-35. [PMID: 25577672 PMCID: PMC4457701 DOI: 10.1016/j.ajog.2014.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
Peripartum hemorrhage accounts for 8% of maternal deaths in the United States, and nearly 27% worldwide. A growing need exists for tactics to spare morbidity given a rise of abnormal placentation that contributes to excessive blood loss at the time of delivery. Approaches such as compression sutures, balloon tamponade, and pelvic artery embolization are not without side effects and potential implications for future fertility. The use of topical hemostatic agents has become widespread in gynecologic and obstetric surgery despite a paucity of distinct studies in the field, and may allow providers to increasingly avoid cesarean hysterectomy. A variety of topical hemostatic agents exist along a wide cost continuum, each characterized by specific efficacy, advantages, drawbacks, and often gaps in long-term data to support safety and impact on future fertility. Herein, we comprehensively review these agents and illustrate a nontraditional use of Monsel solution applied directly to the placental bed in a case of focal placenta accreta. This ultimately contributed to successful uterine preservation with no known adverse sequelae. Monsel solution may have a role in establishing hemostasis in the setting of abnormal placentation, and may be a particularly attractive alternative in resource-poor nations.
Collapse
Affiliation(s)
- Devin T Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Dana M Roque
- University of Maryland School of Medicine, Baltimore, MD
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
| |
Collapse
|
11
|
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]
|
12
|
Cağlar M. Response to: microsurgical principles should be considered in studies addressing adhesion prevention: Çağlar et al. (2014). Arch Gynecol Obstet 2014; 290:611. [PMID: 25027819 DOI: 10.1007/s00404-014-3359-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Mete Cağlar
- Department of Obstetrics and Gynecology, Düzce University School of Medicine, 81000, Konuralp, Duzce, Turkey,
| |
Collapse
|
13
|
Mynbaev OA, Eliseeva MY, Mazitova MI, Malvasi A, Tinelli A. Microsurgical principles should be considered in studies addressing adhesion prevention: Cağlar et al. (2014). Arch Gynecol Obstet 2014; 290:609-10. [PMID: 25022556 DOI: 10.1007/s00404-014-3358-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/02/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Ospan A Mynbaev
- The International Translational Medicine and Biomodeling Research Team, MIPT Center for Human Physiology Studies, Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), 9 Instituskii Lane, Dolgoprudny, Moscow, 141700, Russia,
| | | | | | | | | |
Collapse
|
14
|
Hemostatic gelatine-thrombin matrix (Floseal®) facilitates hemostasis and organ preservation in laparoscopic treatment of tubal pregnancy. Arch Gynecol Obstet 2014; 290:411-5. [PMID: 24816598 DOI: 10.1007/s00404-014-3273-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 04/25/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Laparoscopic salpingotomy has become the gold standard for the treatment of tubal ectopic pregnancy (TEP). Limitations for organ preservation in TEP can result from intra-operative bleeding or potential tubal damage due to application of thermal coagulation. Hemostatic gelatine-thrombin matrix Floseal® allows effective local hemostasis when sutures or thermal coagulation are inadequate or impossible. METHODS We demonstrate in two cases how tubal preservation following effective hemostasis can be achieved by local application of gelatine-thrombin matrix. RESULTS In both cases, the ectopic pregnancy was localized in the ampullar part of the right tube, with gestational sac diameter of 38 and 15 mm, respectively, and visible embryos of 25 and 6.5 mm, respectively. After laparoscopic salpingotomy and evacuation of TEP, diffuse bleeding from the implantation site at the tubal wall was treated with the hemostatic matrix. Punctual bipolar coagulation was used only in Case 1 for striking bleeding from incision margins. Both patients were discharged without complications within 24-48 h after operation. CONCLUSIONS Hemostatic gelatine-thrombin matrix Floseal® minimizes tissue damage and optimizes local hemostasis. The use of Floseal® enhances the chance of organ preservation in the laparoscopic treatment of TEP.
Collapse
|
15
|
Increased adhesion formation after gelatin–thrombin matrix application in a rat model. Arch Gynecol Obstet 2014; 290:501-6. [DOI: 10.1007/s00404-014-3249-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 04/03/2014] [Indexed: 01/01/2023]
|
16
|
Uterine packing with chitosan-covered gauze for control of postpartum hemorrhage. Am J Obstet Gynecol 2013; 209:225.e1-5. [PMID: 23727525 DOI: 10.1016/j.ajog.2013.05.055] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/30/2013] [Accepted: 05/28/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the use of gauze covered with chitosan, a potent hemostatic agent derived from chitin, in the treatment of postpartum hemorrhage (PPH). STUDY DESIGN Patients suffering from postpartum hemorrhage were treated by uterine packing with chitosan-covered gauze, either through the hysterotomy in case of cesarean delivery or transvaginally, for up to 24 hours. RESULTS Chitosan-covered gauze was used in 19 cases of postpartum hemorrhage due to uterine atony, placenta accreta/increta, or anticoagulation, including 5 severe cases where a hysterectomy seemed inevitable otherwise. In all but one case, the bleeding stopped and further interventions were avoided. Over comparable periods of time (18 months) and births (3822 vs 4077) before and after the introduction of the chitosan gauze in our clinic, the rate of peripartum hysterectomies was reduced by 75% (8 vs 2; odds ratio, 4.27; P = .044). CONCLUSION Chitosan-covered gauze is a viable option in the treatment of (severe) postpartum hemorrhage. It is easy to use and requires no special training. It can be used after both vaginal and cesarean deliveries, and there are no adverse side effects. Furthermore, it is very inexpensive compared with other treatment options, making it suitable for use also in low resource-countries, where the death toll due to postpartum hemorrhage is especially high.
Collapse
|
17
|
Antony KM, Dildy GA. Postpartum hemorrhage: the role of the Maternal-Fetal Medicine specialist in enhancing quality and patient safety. Semin Perinatol 2013; 37:246-56. [PMID: 23916023 DOI: 10.1053/j.semperi.2013.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Postpartum hemorrhage in excess of 1000 mL affects 2.9-4.3% of deliveries in North America and the prevalence is increasing (Calvert et al., 2012(1); Callaghan et al., 2010(2)). Given the unpredictable nature of most postpartum hemorrhages, all obstetric providers must understand the initial steps in the assessment and management of this emergency. In this monograph we will review the potential role of the Maternal-Fetal Medicine (MFM) specialist in managing this acute obstetric emergency. MFMs are uniquely positioned to develop hospital protocols, advocate for investment in resources to optimize outcomes, and utilize novel educational models, such as simulation, to educate other providers on the recognition and management of this condition. MFMs can also aid in the antepartum diagnosis of abnormal placentation, which is an increasingly common risk factor for severe hemorrhage.
Collapse
Affiliation(s)
- Kathleen M Antony
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, 6651 Main St, 10th Floor, Houston, TX 77030, USA.
| | | |
Collapse
|
18
|
A local hemostatic agent for the management of postpartum hemorrhage due to placenta previa and placenta accreta: a cross-sectional study. Arch Gynecol Obstet 2013; 288:543-9. [PMID: 23532388 DOI: 10.1007/s00404-013-2812-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/13/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the use of a local hemostatic agent (LHA) for the management of postpartum hemorrhage (PPH) due to bleeding of the placental bed in patients taken to caesarean section at Fundación Santa Fe de Bogotá University Hospital. SAMPLE A total of 41 pregnant women who had a caesarean section and developed PPH. METHODS A cross-sectional study. Analysis of all cases of PPH during caesarean section presented from 2006 up to and including 2012 at Fundación Santa Fe de Bogotá University Hospital. MAIN OUTCOME MEASURE Emergency hysterectomy due to PPH. RESULTS The proportion of hysterectomies was 5 vs. 66 % for the group that received and did not receive management with a LHA respectively (PR 0.07, CI 95 % 0.01-0.51 p < 0.01). For the group managed without a LHA, 80 % of patients needed hemoderivatives transfusion vs. 20 % of patients in the group managed with a LHA (PR 0.24, CI 95 % 0.1-0.6 p < 0.01). A reduction in the mean days of hospitalization in addition to a descent in the proportion of patients admitted to the intensive care unit (ICU) was noticed when comparing the group that received a LHA versus the one that did not. CONCLUSION An inverse association between the use of a LHA in patients with PPH due to bleeding of the placental bed and the need to perform an emergency obstetric hysterectomy was observed. Additionally there was a significant reduction in the mean duration of hospital stay, use of hemoderivatives and admission to the ICU.
Collapse
|
19
|
Li L, Xu DB, Zhao XL, Hao TY. Combination analysis of Bub1 and Mad2 expression in endometrial cancer: act as a prognostic factor in endometrial cancer. Arch Gynecol Obstet 2013; 288:155-65. [PMID: 23334889 DOI: 10.1007/s00404-012-2706-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 12/28/2012] [Indexed: 12/26/2022]
Abstract
INTRODUCTION This study aimed to evaluate the diagnostic value of Bub1 and Mad2 together in endometrial cancer. MATERIALS AND METHODS Sixty-three patients with endometrial cancer, including EECs and NEECs, were examined statistically. Bub1 and Mad2 in patient tissues were detected by indirect streptavidin-biotin-peroxidase complex method. RESULTS 39 cases (61.9 %) were in clinical stage I, 17 cases (27 %) in stage II, 5 (7.9 %) in stage III and 2 cases (3.2 %) in stage IV. Bub1 positive and Mad2 positive rate were identified in 18 and 54 patients. The lower positive of Bub1 and higher positive rate of Mad2 were related to clinical stage and histological grade of endometrial cancer (P = 0.009, 0.002, respectively), especially in NEECs. The expression of Bub1 was negatively correlated with Mad2 and Mtp53 (both P < 0.05). The expression of Mad2 with Mtp53 was positively correlated (P < 0.05). Statistically significant difference between Bub1/Mad2 expression and survival was discovered in endometrial cancer. Specificity and sensitivity of combination between Bub1 negative and Mad2 positive cases were higher than those alone in NEEC subtype. Bub1 and Mad2 are associated with histological differentiation, clinical stage and decreased postoperative survival in endometrial cancer. CONCLUSIONS The combination analysis of Bub1 and Mad2 might be the valuable prognostic, even diagnostic clinicopathologic factor which can be applicable in routine examination.
Collapse
Affiliation(s)
- Lin Li
- Department of Endocrinology, The General Hosipital of Jinan Military Command, Jinan, Shandong 250031, China
| | | | | | | |
Collapse
|
20
|
|
21
|
Nandi A, Wallace S, Moore J. Use of FloSeal to stop persistent intraoperative bleeding during caesarean section. J OBSTET GYNAECOL 2012; 32:34-5. [PMID: 22185532 DOI: 10.3109/01443615.2011.623804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Nandi
- Department of Obstetrics and Gynecology, Nottingham University Hospital, Nottingham, UK.
| | | | | |
Collapse
|
22
|
Lemmer R, Albrech M, Bauer G. Use of FloSeal hemostatic matrix in a patient with severe postpartum hemorrhage. J Obstet Gynaecol Res 2012; 38:435-7. [PMID: 22229547 DOI: 10.1111/j.1447-0756.2011.01716.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
FloSeal (hemostatic gelatin matrix with a human-derived thrombin component; Baxter Healthcare, Deerfield, IL, USA) hemostatic matrix is used as an adjunct to hemostasis when conventional procedures have proved ineffective. In the present case, FloSeal was used in combination with transfusions, NovoSeven (recombinant activated human factor VIIa; Novo Nordisk, Copenhagen, Denmark) and compression to achieve hemostasis in a patient with postpartum bleeding and hypofibrinogenemia due to primary acute fatty liver of pregnancy. The patient presented with signs of acute hepatic failure, modified renal failure and bleeding disorder at week 37 of pregnancy. She suffered persistent hemorrhage after a soft vacuum-assisted delivery. Local hemostasis was achieved, but not maintained and metrorrhagia resumed requiring transfusion. FloSeal was applied intrauterine and to the vaginal walls, and stable hemostasis was achieved after 2 h. At the one-month post-delivery visit, anatomic and physiological status had returned to normal, although the patient had low fibrinogen and prothrombin activity. This case demonstrates the safety and effectiveness of FloSeal in combination with conventional procedures to achieve hemostasis in postpartum bleeding in a patient with hypofibrinogenemia.
Collapse
Affiliation(s)
- Robert Lemmer
- Bohler Clinic, Kirchberg Hospital, Luxembourg, Luxembourg.
| | | | | |
Collapse
|