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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: 1] [Impact Index Per Article: 0.3] [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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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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Fox KA, Shamshirsaz AA, Carusi D, Secord AA, Lee P, Turan OM, Huls C, Abuhamad A, Simhan H, Barton J, Wright J, Silver R, Belfort MA. Conservative management of morbidly adherent placenta: expert review. Am J Obstet Gynecol 2015; 213:755-60. [PMID: 25935779 DOI: 10.1016/j.ajog.2015.04.034] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 11/16/2022]
Abstract
Over the last century, the incidence of placenta accreta, increta, and percreta, collectively referred to as morbidly adherent placenta, has risen dramatically. Planned cesarean hysterectomy at the time of cesarean delivery is the standard recommended treatment in the United States. Recently, interest in conservative management has resurged, especially in Europe. The aims of this review are the following: (1) to provide an overview of methods used for conservative management, (2) to discuss clinical implications for both clinicians and patients, and (3) to identify areas in need of further research.
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Affiliation(s)
| | | | | | | | - Paula Lee
- Duke University Medical Center, Durham, NC
| | - Ozhan M Turan
- University of Maryland School of Medicine, Baltimore, MD
| | - Christopher Huls
- Phoenix Perinatal Associates/Medivax, Banner Good Samaritan Medical Center, University of Arizona, Phoenix, AZ
| | | | - Hyagriv Simhan
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Jason Wright
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Robert Silver
- University of Utah Medical School, Salt Lake City, UT
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Ferrazzani S, Iadarola R, Perrelli A, Botta A, Moresi S, Salvi S, Santucci S, Degennaro VA, De Carolis S. Use of an intrauterine inflated catheter balloon in massive post-partum hemorrhage: a series of 52 cases. J Obstet Gynaecol Res 2015; 40:1603-10. [PMID: 24888923 DOI: 10.1111/jog.12404] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/14/2014] [Indexed: 11/27/2022]
Abstract
AIM Massive post-partum hemorrhage (PPH) is an important cause of maternal death that occurs as a complication of delivery. We report a large case series to evaluate the efficacy of uterine balloon tamponade to treat PPH avoiding hysterectomy. MATERIAL AND METHODS This prospective study was conducted in two Italian hospitals (from December 2002 to July 2012). Fifty-two patients with PPH not responsive to uterotonics were treated by Rusch balloon. A follow-up was conducted among the study population to assess the subsequent fertility. RESULTS The most frequent cause of PPH was atony (59.6%), followed by placenta previa (21.2%), placenta accreta (9.6%), and placenta previa and accreta (9.6%). The balloon success rate to control hemorrhage was 75%. From the sample of 52 patients, 13 patients needed additional procedures. In three failure cases, other conservative techniques were used and the overall effectiveness of them was 80.7%. The follow-up group consisted of 31 women. Of these women, 24 women (77.4%) had no further pregnancies, but only one due to sterility. Four of seven patients with subsequent pregnancies made it to term without complications. CONCLUSIONS The Rusch balloon is effective in controlling non-traumatic PPH in 75% of cases. It is simple to use, readily available and cheap. If necessary, this technique does not exclude other procedures. We suggest that this balloon should be included routinely in the PPH protocol.
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Affiliation(s)
- Sergio Ferrazzani
- Department of Obstetrics and Gynaecology, Catholic University of Sacred Heart
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A modified suture technique for hemorrhage during cesarean delivery complicated by complete placenta previa. Int J Gynaecol Obstet 2015; 129:26-9. [DOI: 10.1016/j.ijgo.2014.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/28/2014] [Accepted: 12/22/2014] [Indexed: 11/22/2022]
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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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Georgiou C. A review of current practice in using Balloon Tamponade Technology in the management of postpartum haemorrhage. HYPERTENSION RESEARCH IN PREGNANCY 2014. [DOI: 10.14390/jsshp.2.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christos Georgiou
- Faculty Science, Medicine and Health, Graduate School of Medicine, University of Wollongong
- Wollongong Hospital, Australia
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Beckmann MM, Chaplin J. Bakri balloon during cesarean delivery for placenta previa. Int J Gynaecol Obstet 2013; 124:118-22. [PMID: 24262684 DOI: 10.1016/j.ijgo.2013.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 08/01/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine if the use of a Bakri balloon at cesarean delivery (CD) for placenta previa is associated with a reduced need for additional surgical or pharmacologic measures and less blood loss than usual practices. METHODS In a randomized controlled trial, 52 women undergoing CD for placenta previa were randomly allocated 1:1 into an intervention arm (prophylactic Bakri balloon immediately following placental delivery) or a control arm (use of any usual surgical/pharmacologic measures to achieve hemostasis). The primary outcomes were a clinician's decision to undertake further intervention to control bleeding, and the difference between preoperative and postoperative hemoglobin levels. RESULTS Although fewer women in the intervention group required additional measures to achieve hemostasis during CD, the difference between the groups was not significant (relative risk 0.54; 95% confidence interval, 0.19-1.57). The change in hemoglobin level among women in the intervention arm was also similar to that among controls (2.3g/dL; 95% confidence interval, -4.4 to 8.9). CONCLUSION The prophylactic use of a Bakri balloon at CD for placenta previa tended to be of benefit, with no evidence of harm or patient dissatisfaction, but the need for additional medical/surgical measures to control blood loss was not significantly reduced. Australian New Zealand Clinical Trials Registry:ACTRN12613000348752.
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Affiliation(s)
- Michael M Beckmann
- Mater Health Services, Brisbane, Australia; Mater Medical Research Institute, Brisbane, Australia.
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Kondoh E, Kawasaki K, Kawamura A, Ueda A, Fujita K, Konishi I. Successful management of intraoperative hemorrhage from placenta previa accreta: intrauterine tamponade balloons brought out through the abdominal wall. J Matern Fetal Neonatal Med 2013; 27:309-11. [DOI: 10.3109/14767058.2013.809418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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