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Habek D, Mikuš M, Cerovac A. Lower Uterine Segment Corrugated Sutures in Hemorrhage during Cesarean Section because Previal and/or Placenta Accreta Spectrum: Case Reports Series and Literature Review. Z Geburtshilfe Neonatol 2024; 228:377-381. [PMID: 38830385 DOI: 10.1055/a-2313-0948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES We present the original technique of compression hemostatic sutures on the lower uterine segment due to early postpartum hemorrhage during cesarean section, with a literature review. METHODS A retrospective clinical case study was conducted at the tertiary perinatal center. Twelve patients had nine planned and three urgent cesarean sections due to antenatally verified placenta previa and/or placenta accreta spectrum and defined early postpartum hemorrhage > 1000 mL during cesarean section. As the use of uterotonics failed to produce any effect and hemorrhage persisted, compression sutures of the lower uterine segment were made by our own technique, as follows: below the hysterotomy, a horizontal corrugated suture is placed from the right to the left corner and after 2-3 cm vertically and backwards at several sites from the left to the right corner, where it is tightened. RESULTS Seven patients had one cesarean section, three patients had two cesarean sections, and seven patients had pregnancy from the in vitro fertilization procedure in their history. There were six patients with placenta previa and six patients with anterior invasive placenta accreta or increta. Original hemostatic procedure was applied successfully in ten cases, and after placement of O'Leary suture and persistent bleeding in two cases. In this group, no hysterectomy was performed, and patients received blood transfusion of 440-880 mL. Three patients later had spontaneous pregnancies. CONCLUSION Our own hemostatic method with a simple technique, fast learning, and minimal logistics contributes to successful management of this currently global problem of morbidly adherent placenta previa.
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Affiliation(s)
- Dubravko Habek
- University Department of Gynecology and Obstetrics, Clinical Hospital "Merkur" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia
- Croatian Academy of Medical Sciences Zagreb, Croatia
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Anis Cerovac
- Department of Gynaecology and Obstetrics, General Hospital Tešanj, Tešanj, Bosnia and Herzegovina
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Erin R, İssak A, Baki Erin K, Kulaksiz D, Bayoğlu Tekin Y. The Efficiency of Temporary Uterine Artery Ligation on Prevention of the Bleeding in Cesarean Section. Gynecol Obstet Invest 2021; 86:486-493. [PMID: 34718233 DOI: 10.1159/000519370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/29/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to evaluate the effect of temporary ligation of the uterine artery on postpartum bleeding during uncomplicated cesarean section. DESIGN This was a prospective, randomized, and controlled study. We recruited a total of 200 patients, including 100 cases and 100 controls. METHODS The bilateral uterine artery was temporarily clamped 2 cm below the uterine incision in the study group and compared with controls. Patient demographics, the amount of intraoperative bleeding, the duration of the operation, the closure time of the uterine incision, the need for additional uterotonics, the need for additional sutures, and the hemoglobin values before and after birth were assessed. RESULTS The mean value of the amount of bleeding in the clamped and control groups was 267.3 ± 131.8 mL and 390.2 ± 116.4 mL, respectively. The amount of bleeding was significantly decreased for clamped group (p < 0.001). A significant reduction occurred in the results of pre- and postoperative values of hemoglobin and hematocrit difference, operation duration, and the closing time of the uterine incision in the experimental group which has temporary uterine artery clamping. LIMITATIONS The cases of recurrent cesareans were not included in this study. CONCLUSION Temporary uterine artery ligation can be used to reduce the amount of bleeding during uncomplicated cesarean delivery and prevent postpartum hemorrhage.
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Affiliation(s)
- Recep Erin
- University of Health Sciences, Trabzon Kanuni Health Practice and Research Center, Trabzon, Turkey
| | - Ahmed İssak
- University of Health Sciences, Somalia Mogadishu Recep Tayyip Erdogan Health Practice and Research Center, Mogadishu, Somalia
| | - Kübra Baki Erin
- University of Health Sciences, Trabzon Kanuni Health Practice and Research Center, Trabzon, Turkey
| | - Deniz Kulaksiz
- University of Health Sciences, Trabzon Kanuni Health Practice and Research Center, Trabzon, Turkey
| | - Yeşim Bayoğlu Tekin
- University of Health Sciences, Trabzon Kanuni Health Practice and Research Center, Trabzon, Turkey
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Radaelli T, Ferrari MM, Duiella SF, Gazzola FG, Campoleoni M, Merlini C, Martinetti L, Ambrosini MT, Ossola MW, Nicolini A. Prophylactic intraoperative uterine artery embolization for the management of major placenta previa. J Matern Fetal Neonatal Med 2020; 35:3359-3364. [PMID: 32928020 DOI: 10.1080/14767058.2020.1818218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Placenta previa is a major cause of maternal morbidity and mortality, associated to a high risk of peripartum hemorrhage and hysterectomy. We aimed to verify if prophylactic intraoperative uterine artery embolization in patients with placenta previa and at least one additional risk of bleeding (major placenta previa), can reduce hemorrhage, need for blood transfusions, peripartum hysterectomy and maternal morbidity. MATERIALS AND METHODS We enrolled 76 patients with major placenta previa; a specific multidisciplinary protocol was designed for management, including ultrasound evaluation, hospitalization at 34 weeks, antenatal corticosteroids and scheduled cesarean section at 35-36 weeks. 44 patients (control group or CTR) were treated with elective cesarean section, 32 patients (embolized group or EMB) underwent selective catheterization of bilateral uterine arteries before cesarean section and subsequent uterine embolization. In both cases cesarean section was performed by a senior surgeon. RESULTS Significant differences were found in term of intraoperative blood loss (CTR: 1431 ml; EMB: 693 ml); despite an high percentage of CTR patients had a bleeding greater than 1000 ml (56%), the need for blood transfusion was not significantly different between the two groups. Time of surgery was higher in the EMB group, considering that embolization procedure required approximatively 30 min. Three patients from the CTR group needed hysterectomy and ICU admission, compared to none in the EMB group. Duration of hospitalization and neonatal outcome were similar. Uterine embolization was not related to any short or long-term complications; return to normal menses and preservation of fertility were confirmed at follow up. CONCLUSIONS Our results are promising, although we believe that a major contribution is referable to the multidisciplinary approach rather than the procedure itself. Nevertheless, we demonstrated the feasibility and safety of preventive uterine embolization in patients with placenta previa; in order to establish its prophylactic role in the prevention of peripartum hemorrhage, randomized trial should be carried out, on a larger population.
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Affiliation(s)
- Tatjana Radaelli
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Maria M Ferrari
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Silvia F Duiella
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Federica G Gazzola
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Mauro Campoleoni
- Department of Medical Physics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Claudia Merlini
- Department of Anesthesiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Laura Martinetti
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Maria T Ambrosini
- Department of Anesthesiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Manuela W Ossola
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Antonio Nicolini
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
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Fan D, Wu S, Ye S, Wang W, Wang L, Fu Y, Zeng M, Liu Y, Guo X, Liu Z. Random placenta margin incision for control hemorrhage during cesarean delivery complicated by complete placenta previa: a prospective cohort study. J Matern Fetal Neonatal Med 2018; 32:3054-3061. [PMID: 29577780 DOI: 10.1080/14767058.2018.1457638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction: Complete placenta previa (CPP) is one of the most problematic types of abnormal placenta, which is further complicated by placenta accreta or percreta that can unexpectedly lead to catastrophic blood loss, infection, multiple complications, emergency hysterectomy, and even death. The present study aimed to assess the efficacy of random placenta margin incision in controlling intraoperative and total blood loss during cesarean section for CPP women. Methods: A prospective cohort study, including a total of 100 consecutive pregnant women with CPP, was performed at a tertiary university-affiliated medical center between March 2016 and July 2017. All of them underwent random placenta margin incision, and intraoperative and total blood loss were analyzed. Through antenatal diagnosis using color Doppler, women were further divided into abnormally invasive placenta (AIP) and non-AIP groups, and anterior and posterior placenta groups. The protocol was registered with the Clinical Trial Registry under registration number NCT02695069. Results: Mean maternal age and gestational age at delivery were 32.26 ± 5.03 years old and 36.21 ± 2.07 weeks, respectively. Total duration of the surgical procedure time was 52.50 (42.43-64.00) min. Median estimated intraoperation blood loss was 746.43 (544.44-1092.86) ml. Total blood loss was 875.00 (604.50-1196.67) ml, and 38 (38.0%) had post-partum hemorrhage. The change from baseline in the median hemoglobin level was -0.33 (6.00-13.20). No women underwent hysterectomy due to massive hemorrhage during the study period. No women had an intraoperative urinary bladder injury, postoperative wound infection, and required relaparotomy, owing to intra-abdominal bleeding. The median hospitalization time was 5.41 (4.18-7.58) d. Conclusion: The random placenta margin incision may be a potentially valuable surgical procedure to control the volumes of intraoperative and postoperative blood loss and reduce the incidence of postpartum hemorrhage among women with complete placenta previa.
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Affiliation(s)
- Dazhi Fan
- a Foshan Institute of Fetal Medicine , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,c Department of Epidemiology & Biostatistics, School of Public Health , Anhui Medical University , Hefei , China
| | - Shuzhen Wu
- a Foshan Institute of Fetal Medicine , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Shaoxin Ye
- a Foshan Institute of Fetal Medicine , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Wen Wang
- b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Lijuan Wang
- b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Yao Fu
- b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Meng Zeng
- b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Yan Liu
- b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Xiaoling Guo
- a Foshan Institute of Fetal Medicine , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
| | - Zhengping Liu
- a Foshan Institute of Fetal Medicine , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China.,b Department of Obstetrics , Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan , Foshan , China
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Li GT, Li XF, Li J, Liu YJ, Xu HM. Reflexed Compression Suture for the Management of Atonic Postpartum Hemorrhage with an Abnormally Adherent Placenta. Gynecol Obstet Invest 2015; 80:228-33. [DOI: 10.1159/000373887] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 01/07/2015] [Indexed: 11/19/2022]
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Ji W, Wang W, Sun S, Wu J, Xu W, Tao D, Xu C, Fu X, Chen Y, Yang S. A clinical analysis of uterine artery embolisation in the treatment of placenta praevia or placenta praevia state. J OBSTET GYNAECOL 2014; 34:585-7. [PMID: 24911560 DOI: 10.3109/01443615.2014.919999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to investigate the efficiency of uterine artery embolisation (UAE) for postpartum haemorrhage (PPH) related to placenta praevia. A total of 45 women with placenta praevia or placenta praevia state underwent UAE before inducing labour. The locations of uterine artery and placenta were determined through selective and super-selective catheterisation into the internal iliac artery and uterine artery digital subtraction angiography (DSA). The target arteries were then super-selectively catheterised and embolised using small pieces of gelatin sponge. The above processes were repeated until the darkly stained areas of placenta were no longer developing. The success rate of UAE was 100%. There was no longer haemorrhage after embolisation for all the cases of labour induction and the average volume of blood loss was 56 ml. UAE is an effective, reliable and minimally traumatic treatment method for preventing postpartum haemorrhage after induction of labour in patients with placenta praevia state.
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Affiliation(s)
- W Ji
- Vascular Interventional Center, Taizhou Hospital of Zhejiang Province , Taizhou, Zhejiang Province , China
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Papoutsis D, Georgantzis D, Daccò MD, Halmos G, Moustafa M, Mesquita Pinto AR, Magos A. A Rare Case of Asherman's Syndrome after Open Myomectomy: Sonographic Investigations and Possible Underlying Mechanisms. Gynecol Obstet Invest 2014; 77:194-200. [DOI: 10.1159/000357489] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 11/20/2013] [Indexed: 11/19/2022]
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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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McLaurin R, Geraghty S. Placenta praevia, placental abruption and amphetamine use in pregnancy: A case study. Women Birth 2013; 26:138-42. [DOI: 10.1016/j.wombi.2012.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/25/2012] [Accepted: 11/12/2012] [Indexed: 11/26/2022]
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