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Takahashi H, Baba Y, Usui R, Suzuki H, Horie K, Yano H, Ohkuchi A, Matsubara S. Hemostatic effect of combined procedures for placenta previa: cervix-holding, intrauterine balloon, and uterine compression suture. J Matern Fetal Neonatal Med 2021; 35:8710-8716. [PMID: 34758709 DOI: 10.1080/14767058.2021.1999922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Various procedures have been introduced to achieve hemostasis for postpartum hemorrhage (PPH) in placenta previa (PP). This study attempted to clarify the effectiveness of the combined use of three hemostatic procedures: Matsubara-Takahashi cervix-holding (MT-holding), intrauterine balloon (IUB), and uterine compression suture (UCS). STUDY DESIGN This was a historical cohort study on the hemostatic effect of combined procedures for patients with placenta previa (PP) undergoing cesarean section between April 2006 and December 2018. Until 2011 (2006-2011), we used MT-holding alone, whereas since 2012 we have also been using IUB and UCS: MT-holding alone was used in the former period whereas three procedures (MT-holding, IUB, UCS, and their combinations) have been used in the latter period. Perinatal outcomes were compared between 2006-2011 (before group) and 2012-2018 (after group). RESULTS Of 416 patients with PP, excluding 273 patients with cesarean hysterectomy or no hemostatic procedure, the remaining 143 patients were analyzed. In the after group, intraoperative blood loss, the percentage of patients with postoperative blood loss ≥ 500 ml, and incidence of autologous blood transfusion were significantly lower than in the before group. Multivariate analysis showed that postoperative blood loss ≥ 500 ml decreased in the after group (adjusted OR: 0.3, 95%CI: 0.1-0.8, compared with the before group). CONCLUSION PPH decreased after introducing the combination of hemostatic procedures in patients with PP. Further studies are needed to determine the best combination and optimal indication for combining hemostatic procedures for PP.
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Affiliation(s)
- Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Yosuke Baba
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Rie Usui
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Kenji Horie
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Hitoshi Yano
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
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Takahashi H, Baba Y, Usui R, Suzuki H, Ohkuchi A, Matsubara S. Laterally-positioned placenta in placenta previa. J Matern Fetal Neonatal Med 2019; 33:2642-2648. [PMID: 30518276 DOI: 10.1080/14767058.2018.1556634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To clarify perinatal outcomes of patients with placenta previa (PP) with the placenta mainly positioned in the lateral uterine wall (lateral PP), thereby clinically characterizing this condition.Study design: The retrospective cohort study was performed involving patients with lateral PP between January 2006 and December 2016. The placental position was determined and classified by magnetic resonance imaging.Results: This study included 98 patients with PP, which was classified into three types according to the main placental position sites: lateral (n = 30), anterior (n = 32), and posterior (n = 36) PP. Overall, the median blood loss at cesarean section (CS) was 1808 mL and transfusion was performed for 78 patients (80%). Univariate analysis showed that patients with lateral PP bled less at CS than those with non-lateral PP (anterior + posterior PP) [median 1510 (interquartile range 1080-2168) versus 1975 (1570-2860) mL: p=.02]. The other parameters including rates of conception by assisted reproductive technology, prior CS, antepartum bleeding, and placenta accreta spectrum did not show the significances. Among the three groups of PP (lateral versus anterior versus posterior), patients with lateral PP bled less than those with anterior (p=.05) or posterior (p=.13) PP, but this was nonsignificant [lateral 1510 (1080-2168) versus anterior 2145 (1580-3348) versus posterior 1808 (1533-2555) mL]. When dividing into lateral PP to two types: placenta showing anterior dominancy versus posterior dominancy, patients with lateral PP and anterior dominancy bled more those with posterior dominancy [2430 (1410-3400) versus 1170 (1050-1588) mL: p=.002].Conclusion: Patients with lateral PP bled significantly less than those with non-lateral (anterior or posterior) PP. Patients with lateral PP and anterior dominancy bled more than those with posterior dominancy.
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Affiliation(s)
- Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Yosuke Baba
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Rie Usui
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan
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El-Sharkawy M, Samy A, Latif D, Mahmoud M, Samir D, Abbas AM. The effect of mechanical cervical dilatation during scheduled cesarean section on the blood loss: a randomized controlled trial. J Matern Fetal Neonatal Med 2019; 33:2043-2048. [PMID: 30317902 DOI: 10.1080/14767058.2018.1536742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: This study evaluates the effects of mechanical cervical dilatation during scheduled cesarean section (CS) on intra- and postoperative blood loss.Methods: A single-center randomized double-blind controlled trial (NCT03444792) conducted at a tertiary University Hospital in the period between 1 April 2017 and 31 March 2018 included all women scheduled for scheduled CS under spinal anesthesia if they met our inclusion criteria. Eligible participants were randomized to one of two groups. Group (I): Women with intraoperative cervical dilatation and Group (II): women with no intraoperative cervical dilatation. The primary outcome of this study was the mean volume of total blood loss during CS. The secondary outcomes included the mean reduction in the hemoglobin and hematocrit, the rate of primary postpartum hemorrhage, the duration of surgery, the duration of hospital stay, the rate of wound infection and endometritis.Results: No statistical significant difference between both study groups regarding the baseline characteristics. No significant difference in the intraoperative blood loss between both groups (p = .21); however, there was significantly more postoperative blood loss in group II (p = .001). The total blood loss was significantly higher in group II (912.6 ± 242.1 versus 845.8 ± 188.9 mL) in group I (p = .029). There were significantly lower postoperative hemoglobin and hematocrit levels in group II (p = .014 and .033 respectively). The mean duration of CS was significantly shorter in the cervical dilatation group (p = .002). No difference between both groups regarding the rate of postpartum hemorrhage (PPH) (p = .21), the duration of hospital stay (p = .17), the rate of wound infection (p = .32), the rate of endometritis (p = .82).Conclusions: Mechanical cervical dilatation during scheduled CS could be associated with lower postoperative blood loss, higher postoperative hemoglobin & hematocrit levels and shorter duration of CS.
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Affiliation(s)
- Mohamed El-Sharkawy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Samy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Latif
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Mahmoud
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Samir
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Matsubara-Yano suture: a simple uterine compression suture for postpartum hemorrhage during cesarean section. Arch Gynecol Obstet 2018; 299:113-121. [PMID: 30357496 DOI: 10.1007/s00404-018-4947-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
AIMS The aims of this study were to clarify: (i) the effectiveness of Matsubara-Yano uterine compression suture (MY) to achieve hemostasis in the presence of postpartum hemorrhage (PPH) during cesarean section, (ii) the type of PPH for which MY is effective, (iii) post-operative complications of MY, and (iv) outcomes of pregnancy after MY. METHODS This retrospective observational study was performed using medical records of patients for whom MY had been performed between January 1, 2009 and December 31, 2017. RESULTS MY was performed for 50 patients, with hemostasis achieved in 46 (92%). The other four (8%: 4/50) patients required transarterial embolization or hysterectomy. Of these four, three patients had placenta accreta spectrum (PAS) disorder-related bleeding. Post-operative complications were observed in three (6%: 3/50) patients, with all showing intrauterine infection. All three patients recovered solely with antibiotics. Eight pregnancies were confirmed (five livebirths, two spontaneous abortions in the first trimester, and one case of ongoing pregnancy). Of the five livebirths, one resulted in cesarean hysterectomy due to placenta previa with PAS disorders. CONCLUSIONS MY had a hemostatic effect on PPH. All cases except one with hemostatic failure were associated with PAS disorders, indicating that the hemostatic rate was lower in those with PAS than non-PAS disorders.
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Takeda J, Makino S, Hirai C, Shimanuki Y, Inagaki T, Itakura A, Takeda S. Long-term uterine balloon tamponade for treatment and obliteration of ruptured uterine pseudoaneurysm. Taiwan J Obstet Gynecol 2018; 57:329-331. [PMID: 29880159 DOI: 10.1016/j.tjog.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE Rupture of uterine artery pseudoaneurysm (UAP) is a life-threatening event after childbirth. Hysterectomy or uterine arterial embolization was often needed for hemostasis. However, such procedures may cause severe morbidities for these women. To estimate the efficacy of uterine balloon tamponade (UBT) for controlling ruptured UAP bleeding, a retrospective analysis in a single teaching hospital was performed. MATERIALS AND METHODS We reviewed the medical record of Juntendo University Hospital in 2015. All the women diagnosed with UAP were recruited to this study and management for UAP was investigated. RESULTS Three women were treated with UBT for ruptured UAP. All cases achieved hemostasis. One case had recurrent UAP after 24 h of UBT, and was retreated with UBT for a longer duration. The UAP was obliterated after more than 2 days of UBT in all cases. CONCLUSION UBT has potential as a therapeutic technique not only for treatment of a ruptured UAP but also for obliteration of a UAP.
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Affiliation(s)
- Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Chihiro Hirai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yota Shimanuki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tetsunori Inagaki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Takahashi H, Ohkuchi A, Usui R, Suzuki H, Baba Y, Matsubara S. Matsubara-Takahashi cervix-holding technique for massive postpartum hemorrhage in patients with placenta previa with or without placenta accreta spectrum disorders. Int J Gynaecol Obstet 2017; 140:357-364. [DOI: 10.1002/ijgo.12390] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/12/2017] [Accepted: 11/15/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Hironori Takahashi
- Department of Obstetrics and Gynecology; Jichi Medical University; Shimotsuke Tochigi Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology; Jichi Medical University; Shimotsuke Tochigi Japan
| | - Rie Usui
- Department of Obstetrics and Gynecology; Jichi Medical University; Shimotsuke Tochigi Japan
| | - Hirotada Suzuki
- Department of Obstetrics and Gynecology; Jichi Medical University; Shimotsuke Tochigi Japan
| | - Yosuke Baba
- Department of Obstetrics and Gynecology; Jichi Medical University; Shimotsuke Tochigi Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology; Jichi Medical University; Shimotsuke Tochigi Japan
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Matsubara S. Identifying the vaginal fornix in cesarean hysterectomy for an abnormally invasive placenta: an alternative technique. Am J Obstet Gynecol 2017; 217:493-494. [PMID: 28673790 DOI: 10.1016/j.ajog.2017.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/26/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Shigeki Matsubara
- Departments of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan.
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Factors Contributing to Massive Blood Loss on Peripartum Hysterectomy for Abnormally Invasive Placenta: Who Bleeds More? Obstet Gynecol Int 2016; 2016:5349063. [PMID: 27630716 PMCID: PMC5005569 DOI: 10.1155/2016/5349063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. To identify factors that determine blood loss during peripartum hysterectomy for abnormally invasive placenta (AIP-hysterectomy). Methods. We reviewed all of the medical charts of 11,919 deliveries in a single tertiary perinatal center. We examined characteristics of AIP-hysterectomy patients, with a single experienced obstetrician attending all AIP-hysterectomies and using the same technique. Results. AIP-hysterectomy was performed in 18 patients (0.15%: 18/11,919). Of the 18, 14 (78%) had a prior cesarean section (CS) history and the other 4 (22%) were primiparous women. Planned AIP-hysterectomy was performed in 12/18 (67%), with the remaining 6 (33%) undergoing emergent AIP-hysterectomy. Of the 6, 4 (4/6: 67%) patients were primiparous women. An intra-arterial balloon was inserted in 9/18 (50%). Women with the following three factors significantly bled less in AIP-hysterectomy than its counterpart: the employment of an intra-arterial balloon (4,448 ± 1,948 versus 8,861 ± 3,988 mL), planned hysterectomy (5,003 ± 2,057 versus 9,957 ± 4,485 mL), and prior CS (5,706 ± 2,727 versus 9,975 ± 5,532 mL). Patients with prior CS (-) bled more: this may be because these patients tended to undergo emergent surgery or attempted placental separation. Conclusion. Patients with intra-arterial balloon catheter insertion bled less on AIP-hysterectomy. Massive bleeding occurred in emergent AIP-hysterectomy without prior CS.
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Sakinci M, Kuru O, Olgan S, Gunduz S, Bakir VL, Kaya O, Bakirci IT. Dilatation of the cervix at non-labour caesarean section: Does it improve the patients' perception of pain post-operatively? J OBSTET GYNAECOL 2015; 35:681-4. [PMID: 25642600 DOI: 10.3109/01443615.2015.1004533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our aim was to determine the effect of cervical dilatation at non-labour caesarean section on post-operative pain and maternal morbidity. This prospective, randomised, single-blinded trial was conducted from March 2013 to February 2014. In all, 199 patients were enrolled in the study: 102 in non-dilated group and 97 in cervical dilatation group. Based on Visual Analogue Scale, there were no significant differences between the two groups on post-operative 8th, 24th and 48th hour pain scores. We observed thinner endometrial cavity thickness, shorter operation time and shorter hospitalisation duration in cervical dilatation group. However, change in haemoglobin concentrations and puerperal fever rates were found to be comparable between the groups. In conclusion, intra-operative cervical dilatation does not seem to benefit in terms of post-operative pain, change in haemoglobin concentrations or puerperal fever.
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Affiliation(s)
- M Sakinci
- a Department of Obstetrics and Gynecology , Akdeniz University Faculty of Medicine , Antalya , Turkey
| | - O Kuru
- b Department of Obstetrics and Gynecology , Kanuni Sultan Suleyman Teaching and Research Hospital , Istanbul , Turkey
| | - S Olgan
- a Department of Obstetrics and Gynecology , Akdeniz University Faculty of Medicine , Antalya , Turkey
| | - S Gunduz
- b Department of Obstetrics and Gynecology , Kanuni Sultan Suleyman Teaching and Research Hospital , Istanbul , Turkey
| | - V L Bakir
- c Department of Obstetrics and Gynecology , Haseki Teaching and Research Hospital , Istanbul , Turkey
| | - O Kaya
- b Department of Obstetrics and Gynecology , Kanuni Sultan Suleyman Teaching and Research Hospital , Istanbul , Turkey
| | - I T Bakirci
- b Department of Obstetrics and Gynecology , Kanuni Sultan Suleyman Teaching and Research Hospital , Istanbul , Turkey
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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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Matsubara S, Baba Y, Suzuki H, Suzuki H, Nagashima T, Suzuki M. Uterine compression suture combined with holding the cervix technique: a measure to achieve hemostasis for atonic bleeding during or after cesarean section. Acta Obstet Gynecol Scand 2013; 92:1234-5. [PMID: 23782294 DOI: 10.1111/aogs.12199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Matsubara S, Kuwata T, Usui R, Ohkuchi A. ‘Holding the cervix’ technique for post-partum hemorrhage for achieving hemostasis as well as preventing prolapse of an intrauterine balloon. J Obstet Gynaecol Res 2013; 39:1116-7. [DOI: 10.1111/jog.12019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi Japan
| | - Rie Usui
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi Japan
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Matsubara S, Kuwata T, Usui R, Watanabe T, Izumi A, Ohkuchi A, Suzuki M, Nakata M. Important surgical measures and techniques at cesarean hysterectomy for placenta previa accreta. Acta Obstet Gynecol Scand 2013; 92:372-7. [PMID: 23323568 DOI: 10.1111/aogs.12074] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 12/06/2012] [Indexed: 11/29/2022]
Abstract
For cesarean hysterectomy with placenta previa accreta, "universally achievable" measures are required. We propose eight measures: (i) placement of intra-iliac arterial occlusion balloon catheters; (ii) placement of ureter stents; (iii) "holding the cervix" to identify the site to be transected; (iv) uterine fundal incision; (v) avoidance of uterotonics; (vi) "M cross double ligation" for ligating the ovarian ligament; (vii) "filling the bladder" to identify the bladder separation site and "opening the bladder" for placenta previa accreta with bladder invasion; and (viii) to continue to clamp the medial side of the parametrium or the cervix or employment of the "double edge pick-up" to ligate it. These eight measures are simple, easy, effective, and thus "universally achievable".
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Affiliation(s)
- Shigeki Matsubara
- Departments of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Japan.
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“Holding the cervix” technique: prophylaxis for acute recurrent uterine inversion. Arch Gynecol Obstet 2013; 288:463-5. [DOI: 10.1007/s00404-013-2751-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
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Matsubara S. A simpler alternative to the Sengstaken-Blakemore tube: cervix-holding by forceps to control hemorrhage after cesarean section for placenta previa. J Obstet Gynaecol Res 2012; 38:903-4. [PMID: 22487147 DOI: 10.1111/j.1447-0756.2011.01813.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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