Prophylactic application of Bakri balloon tamponade versus uterine gauze packing during cesarean section in patients with placenta previa

Safety and efficacy of intrauterine balloon tamponade vs uterine gauze packing in managing postpartum hemorrhage: A systematic review and meta-analysis

BACKGROUND

There is debate on whether uterine gauze packing or intrauterine balloon tamponade is safer and more effective as a surgical management option for treating postpartum hemorrhage.

OBJECTIVE

This study aimed to compare intra- and postoperative outcomes of intrauterine balloon tamponade and uterine gauze packing in patients with postpartum hemorrhage.

STUDY DESIGN

A range of databases such as Cochrane and PubMed were searched using terms including "post-partum haemorrhage," "uterine balloon tamponade," and "uterine gauze packing." All observational studies comparing intrauterine balloon tamponade with uterine gauze packing were included. Five studies were identified enrolling 821 adult patients diagnosed with postpartum hemorrhage. Primary outcomes included blood loss volume, success rates, and maternal mortality. Secondary outcomes comprised requiring additional interventions, postoperative hemoglobin levels, and requiring blood transfusions. Fixed and random models were used for analysis.

RESULTS

Intrauterine balloon tamponade seemed to be a superior option to uterine gauze packing. Intrauterine balloon tamponade was better in reducing intraoperative blood loss, with a statistically significant improvement (P<.0001). Cases managed with intrauterine balloon tamponade seemed to have statistically significant shorter operative time (P=.023) and hospital length of stay (P=.020) in one study.

CONCLUSION

Intrauterine balloon tamponade remains more effective and safer as a first-line surgical management option for postpartum hemorrhage compared with uterine gauze packing.

The Effectiveness and Safety of Ropivacaine and Medium-Dose Dexmedetomidine in Cesarean Section

Objective: To study the effects of epidural anesthesia with different doses of dexmedetomidine and ropivacaine on postoperative hemodynamics and neonatal outcome of cesarean section parturients. Methods. A total of 90 parturients who underwent cesarean section admitted to our hospital from January 2019 to January 2020 were selected as the research objects and were divided into groups A, B, and C according to different dosages of dexmedetomidine, with 30 cases in each group. Groups A, B, and C were given dexmedetomidine 0.5 μg/kg, 0.8 μg/kg, 1.0 μg/kg, respectively, combined with 0.2% ropivacaine. The anesthesia effect, traction response, hemodynamic indexes, and neonatal Apgar score of the three groups were compared; the “Numerical Rating Scale (NRS) Score” was used to assess the postoperative pain of the parturients, and the “Ramsay Sedation Scale” was used to assess the sedation state of the parturients. Results. The superior anesthesia effect of group B was obtained compared with groups A and C (P < 0.05). Group B witnessed a lower degree of grade III stretching response, as compared to group A (P < 0.05). In comparison with groups A and C, superior results of the heart rate and mean artery pressure (MAP) of group B at T1 and T2 were obtained (P < 0.05). The neonatal Apgar score in group B was lower than those in groups A and C (P < 0.05), and the NRS score of group B was also lower than that of group A (P < 0.05). Compared with groups A and C, group B yielded a more favorable outcome in terms of the Ramsay score (P < 0.05). Conclusion. The use of medium-dose dexmedetomidine in cesarean section parturients is safer and can effectively reduce the impact on maternal hemodynamics, which is worthy of promotion and application.

Double-uterine-incision in the management of placenta previa complicated by placenta accreta spectrum

OBJECTIVE

To compare the effectiveness of a new double-uterine-incision, based on Ar's incision, with single-uterine-incision during cesarean section in pregnancy concurrently complicated by placenta previa and placenta accreta spectrum.

METHODS

A retrospective cohort study including 260 participants was conducted between January 2014 and June 2019. The participants only underwent Ar's incision in the single-uterine-incision group and participants underwent two uterine incisions in the new double-uterine-incision group. The demographic and clinical characteristics were compared between the two groups.

RESULTS

Fifty-six participants (21.5%) underwent a double-incision, and the other 204 underwent a single-incision. The incidence of previous cesarean delivery (91.1% vs. 68.6%) and anterior placenta (76.8% vs. 53.4%) was higher in the double-incision group. The blood loss (3400 ml vs. 1600 ml) and the need for blood transfusion (100.0% vs. 82.8%) were higher in the double-incision group. There was no significant difference between the two groups (one (1.8%) in the double-incision group and 10 (4.9%) in the single-incision group) in need for subtotal hysterectomy. After adjusting for confounding factors, there was no significant difference between the two groups concerning blood loss, blood transfusion, maternal ICU, or length of hospital stay; and the incidence of subtotal hysterectomy was lower in the double-incision group.

CONCLUSION

This new double-uterine-incision, based on Ar's incision, is an effective and valuable procedure for pregnant women with placenta previa complicated by placenta accreta spectrum, especially in women with a serious condition. It is an option for pregnant women concurrently complicated by placenta previa and placenta accreta spectrum who desire future fertility.