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Effectiveness of transarterial embolisation for intractable postpartum haemorrhage in a disseminated intravascular coagulation state, despite emergency hysterectomy. Clin Radiol 2023; 78:55-60. [PMID: 36307234 DOI: 10.1016/j.crad.2022.08.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE We evaluated the effectiveness of transarterial embolization (TAE) for intractable postpartum hemorrhage in patients with disseminated intravascular coagulation (DIC) despite emergency hysterectomy. MATERIALS AND METHODS We retrospectively assessed TAE performed after emergency hysterectomy in 15 patients between July 2008 and January 2022. Underlying condition, technical success, clinical success, angiographic findings, laboratory findings, pregnancy-modified DIC score (The International Society on Thrombosis and Haemostasis), blood transfusion, ICU (Intensive care unit) admission day, hospital day, in-hospital mortality, and long-term sequelae were evaluated. RESULTS All patients were diagnosed with DIC before embolization, with a 43.9 mean DIC score. All patients showed positive angiographic findings for active bleeding. Thirty-eight bleeding arteries were confirmed. The remnant uterine artery (n=25) was the most common focus of persistent bleeding, followed by the cervicovaginal artery (n=6), pudendal artery (n=3), obturator artery (n=2), vesical artery (n=1), and unspecified artery from the internal iliac artery (n=1). Technical and clinical success rates were 100% (15/15) and 93.3% (14/15), respectively. Mean nadir hemoglobin (Hb) level before embolization was 4.9 g/dL. All patients underwent massive transfusion before embolization (mean 33.2 packs of RBC). Postoperatively, a smaller amount of blood was transfused than before the procedure (mean 10.6 packs of RBC). Mean nadir Hb level after embolization was 8.2 g/dL. There was one instance each of in-hospital death, hypoxic brain damage, and ischemic acute kidney injury. CONCLUSION Despite hysterectomy for postpartum bleeding, there could be multiple residual or uncontrolled bleeding foci, especially in case of DIC, for which TAE could be an effective treatment.
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Liu W, Yin W. Effect of Uterine Artery Ligation and Uterine Artery Embolization on Postpartum Hemorrhage Due to Uterine Asthenia after Cesarean Section and Its Effect on Blood Flow and Function of Uterine and Ovarian Arteries. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1337234. [PMID: 35356624 PMCID: PMC8959990 DOI: 10.1155/2022/1337234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/04/2022] [Indexed: 01/10/2023]
Abstract
Objective To investigate the efficacy of uterine artery ligation (UAL) and uterine artery embolization (UAE) in the treatment of uterine asthenia postpartum hemorrhage (PPH) after cesarean section and its effect on uterine and ovarian artery blood flow and function. Methods 100 patients with uterine asthenia PPH after cesarean section in our hospital from January 2018 to November 2020 were randomly divided into 50 cases in the UAL group and 50 cases in the UAE group. They were followed up for 12 months. The bleeding volume, operation time, immediate hemostasis rate, and hemostasis effective rate; lochia clearance time and menstrual rehydration time; RI and S/D; and serum FSH, E2, and LH levels were compared between the two groups. Results Compared with the UAL group, the amount of bleeding in the UAE group was significantly increased and the operation time was significantly shortened (p < 0.05). There was no significant difference in the immediate hemostatic rate and hemostatic effective rate between the two groups (p > 0.05). There was no significant difference in lochia clearance time and menstrual rehydration time between the two groups (p > 0.05). There was no significant difference in RI and S/D between the two groups (p > 0.05). Compared with before the operation, the levels of FSH and LH in the two groups decreased significantly, and the level of E2 increased significantly (p < 0.05). There was no significant difference between the two groups (p > 0.05). Conclusion The efficacy of UAL and UAE in the treatment of PPH with uterine asthenia after cesarean section and its effect on the blood flow and function of uterine and ovarian arteries are equivalent, but the amount of bleeding in UAL is less and the operation time of UAE is shorter. The appropriate operation method can be selected according to the actual situation.
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Affiliation(s)
- Wufen Liu
- Obstetrics and Reproductive Center, Affiliated Hospital of Yunnan University, Kunming 650021, China
| | - Wei Yin
- Obstetrics and Reproductive Center, Affiliated Hospital of Yunnan University, Kunming 650021, China
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Rouzi AA, Sulaimani M. Damage-Control Surgery for Maternal Near-Miss Cases of Placenta Previa and Placenta Accreta Spectrum. Int J Womens Health 2021; 13:1161-1165. [PMID: 34858065 PMCID: PMC8631974 DOI: 10.2147/ijwh.s334743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose There is paucity of reports on damage control surgery use in near-miss cases associated with placenta previa, and placenta accreta spectrum. The objective is to report the outcome of damage control surgery for the obstetrical hemorrhage in near-miss cases of placenta previa and placenta accreta spectrum. Materials and Methods The records of all women who had damage control surgery defined as abdominopelvic packing, followed by a period of medical stabilization in the intensive care unit for near-miss placenta previa and placenta accreta spectrum at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between November 1, 2007, and March 1, 2020, were identified and reviewed. Results During the study period, seven women met the inclusion criteria. There were three women with placenta previa, three women with placenta previa accreta, and one woman with placenta accreta. Five women had cesarean section followed by laparotomy, hysterectomy, and damage control surgery, one woman had a cesarean hysterectomy and damage control surgery, and one woman had hysterectomy and damage control surgery. Estimated “near-miss” intraoperative bleeding ranged from 2 to 7 liters for the seven women (median 5 L; IQR 3.5, 6), which was managed by massive blood transfusion. Complications included disseminated intravascular coagulation (3 women), intestinal obstruction (1 woman), acute renal failure (1 woman), and vesicovaginal fistula (1 woman). Hospital stay ranged from 8 to 44 days (median 37; IQR 21, 39). Conclusion Damage control surgery can be life-saving. It should be in the armamentarium of the health care providers managing women with placenta previa, and placenta accreta spectrum.
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Affiliation(s)
- Abdulrahim A Rouzi
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Sulaimani
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
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Ma G, Gao L, Li Q, Zhao X. Efficacy of intrauterine Bakri balloon tamponade combined with ascending uterine artery ligation on postpartum hemorrhage. Am J Transl Res 2021; 13:4995-5002. [PMID: 34150084 PMCID: PMC8205799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To observe the efficacy of intrauterine Bakri balloon tamponade (IBBT) combined with ascending uterine artery ligation (AUAL) in the treatment of postpartum hemorrhage (PPH) due to uterine inertia after cesarean section. METHODS A total of 92 patients with PPH due to uterine inertia after cesarean section were divided into a study group (n=46) and a control group (n=46) in accordance with the random number table. The control group was treated with IBBT alone, while the study group was treated with IBBT combined with AUAL. The clinical efficacies, hemorrhage, surgical duration, hospital stay, hemorrhage rate after removal of tamponade, recurrence rate of PPH, changes in coagulation function and quality of life were compared between the two groups. RESULTS The overall response rate (ORR) in the study group was 95.65%, remarkably higher than that of 80.43% in the control group (P < 0.05). The study group had a lesser amount of hemorrhage at 2 h and 24 h after surgery, a longer surgical duration, a shorter hospital stay, and lower hemorrhage rate after removal of tamponade and recurrence rate of PPH than the control group (P < 0.05). After treatment, prothrombin time, activated partial thromboplastin time and fibrinogen in the study group were markedly higher than those in the control group (P < 0.05). Compared with those before treatment, the scores of quality of life in the two groups were elevated at 3 months after treatment (P < 0.05), and the scores of quality of life in the study group were higher than those in the control group at 3 months after treatment (P < 0.05). CONCLUSION IBBT combined with AUAL can effectively alleviate hemorrhage and improve coagulation function and quality of life of patients with PPH due to uterine inertia after cesarean section, exhibiting a definite efficacy and a high safety profile.
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Affiliation(s)
- Guangna Ma
- Department of Obstetrics, Tai'an City Central Hospital Tai'an 271000, Shandong Province, China
| | - Li Gao
- Department of Obstetrics, Tai'an City Central Hospital Tai'an 271000, Shandong Province, China
| | - Qinwen Li
- Department of Obstetrics, Tai'an City Central Hospital Tai'an 271000, Shandong Province, China
| | - Xudong Zhao
- Department of Obstetrics, Tai'an City Central Hospital Tai'an 271000, Shandong Province, China
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Pathiraja PDM, Jayawardane A. Evaluation of Peripartum Hysterectomy in a Tertiary Care Unit and Its Effect on Patients' Long-Term Physical and Mental Wellbeing: Quest Is Not Over When You Save the Life. Obstet Gynecol Int 2021; 2021:5720264. [PMID: 33679986 PMCID: PMC7906802 DOI: 10.1155/2021/5720264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/06/2021] [Accepted: 02/12/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Peripartum hysterectomy can be performed as an elective procedure or as a life-saving emergency procedure in obstetrics. It is associated with significant maternal morbidity and mortality. We report peripartum hysterectomies done during the study period in a tertiary referral centre, Colombo, Sri Lanka. Methodology. We collected data on all severe acute maternal morbidity and mortality events (SAMM) from June 01, 2014, to June 01, 2015, at De Soysa Hospital for Women (DSHW). We invited all women who underwent PPH to complete the 36-Item Short Form Health Survey questionnaire (SF-36) before hospital discharge and at six months after the hysterectomy date to assess their general and mental health before and after surgery. Focus group discussions (FGD) were used to further evaluate the patient experience and to identify service delivery improvements. RESULTS There were eleven peripartum hysterectomies done during the study period for 7160 deliveries. None were primigravida. Median age and gestation were 36 years and 37 weeks, respectively. The commonest indication for peripartum hysterectomy was a morbidly adherent placenta (seven). Nine of the deliveries were elective lower-segment caesarean section and two were vaginal deliveries. Four emergency peripartum hysterectomies were done for primary postpartum haemorrhage (PPH) and two for secondary PPH. All patients required intensive care and there were no maternal deaths. The analysis of SF-36 data revealed that all patients suffered a significant reduction in the quality of life at six months after the surgery. FGD highlighted that most patients needed further counselling and support to improve their physical, psychological, and social wellbeing. Some of the patients were willing to share their experience on voluntary basis to help those undergoing peripartum hysterectomies in the future. CONCLUSION Peripartum hysterectomy is an important life-saving procedure associated with severe maternal morbidity and mortality. This study reveals that the physical, psychological, and social adverse effects would remain in the long term.
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Successful Perioperative Management with Damage Control Surgery in a Patient with Massive Postpartum Hemorrhage of More Than 20,000 mL. Case Rep Anesthesiol 2020; 2020:8872925. [PMID: 32607258 PMCID: PMC7315259 DOI: 10.1155/2020/8872925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 11/17/2022] Open
Abstract
Disseminated intravascular coagulation (DIC) in obstetrics is related to postpartum hemorrhage and has been a leading cause of maternal death. We here report a successful treatment, via damage control surgery (DCS), of a life-threatening massive hemorrhage of more than 20,000 mL due to DIC. A 30-year-old female was admitted to our hospital because of atonic bleeding. Since she was having a uterine rupture, an emergency hysterectomy was performed. Because of the severe DIC (fibrinogen, 65 mg/dL; platelet count, 6.0 × 109/L), oozing persisted after the hysterectomy; thus, intraperitoneal gauze packing was performed as DCS. Afterwards, the coagulopathy was corrected, and the gauze was removed on the second postoperative day (POD 2). The patient was discharged without complications on POD 16. The present case demonstrated that performing DCS and waiting for improvement of the coagulation system can be one of the treatment options for management of patients with severe DIC.
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Abstract
Damage-control surgery (abdominopelvic packing followed by a period of medical stabilization in the intensive care unit) is a life-saving intervention usually reserved for critically injured patients who may not survive an attempt to achieve hemostasis and complete repair of the damage in the operating room. Most obstetricians have little or no experience in this area, although the use of damage-control surgery in selected cases may be life-saving. This approach should be considered when arterial bleeding has been controlled and persistent bleeding is deemed to be secondary to coagulopathy that is refractory to blood product replacement, particularly in the presence of hypothermia, acidosis, and vasopressor requirement. A prototypical (albeit hypothetical) case is described here in which damage-control surgery is indicated.
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Govind A, Yoong W. Response to Letter to Editor 'Additional procedures for pelvic gauze packing for obstetric haemorrhage'. Aust N Z J Obstet Gynaecol 2019; 59:E6. [PMID: 30950047 DOI: 10.1111/ajo.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Abha Govind
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
| | - Wai Yoong
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
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Muñoz M, Stensballe J, Ducloy-Bouthors AS, Bonnet MP, De Robertis E, Fornet I, Goffinet F, Hofer S, Holzgreve W, Manrique S, Nizard J, Christory F, Samama CM, Hardy JF. Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:112-136. [PMID: 30865585 PMCID: PMC6476742 DOI: 10.2450/2019.0245-18] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 04/20/2023]
Abstract
Patient blood management (PBM) is the timely application of evidence-informed medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis, and minimise blood loss in an effort to improve patient outcomes. The aim of this consensus statement is to provide recommendations on the prevention and treatment of postpartum haemorrhage as part of PBM in obstetrics. A multidisciplinary panel of physicians with expertise in obstetrics, anaesthesia, haematology, and transfusion medicine was convened by the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) in collaboration with the International Federation of Gynaecology and Obstetrics (FIGO), the European Board and College of Obstetrics and Gynaecology (EBCOG), and the European Society of Anaesthesiology (ESA). Members of the task force assessed the quantity, quality and consistency of the published evidence, and formulated recommendations using the system developed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. The recommendations in this consensus statement are intended for use by clinical practitioners managing perinatal care of women in all settings, and by policy-makers in charge of decision making for the update of clinical practice in health care establishments.
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Affiliation(s)
- Manuel Muñoz
- Perioperative Transfusion Medicine, Department of Surgical Specialities, Biochemistry and Inmunology, University of Málaga, Málaga, Spain
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France (NATA)
| | - Jakob Stensballe
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France (NATA)
- Section for Transfusion Medicine, Capital Region Blood Bank, and Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Marie-Pierre Bonnet
- Department of Anaesthesia and Intensive Care Medicine, Cochin University Hospital, Paris, France
| | - Edoardo De Robertis
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University Federico II, Naples, Italy
- European Society of Anaesthesiology, Brussels, Belgium (ESA)
| | - Ino Fornet
- Deparment of Anesthesiology, University Hospital Puerta de Hierro, Madrid, Spain
| | - François Goffinet
- Department of Obstetrics and Gynecology, Port-Royal Maternity, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Stefan Hofer
- Clinic for Anesthesiology, Intensive Care and Emergency Medicine I, Westpfalz Hospital, Kaiserslautern, Germany
| | - Wolfgang Holzgreve
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
- International Federation of Gynaecology and Obstetrics, London, UK (FIGO)
| | - Susana Manrique
- Deparment of Anesthesiology, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Jacky Nizard
- Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié Salpêtrière, Université Pierre et Marie Curie-Paris 6, Paris, France
- European Board and College of Obstetrics and Gynaecology, Brussels, Belgium (EBCOG)
| | - François Christory
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France (NATA)
| | - Charles-Marc Samama
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France (NATA)
- Department of Anaesthesia and Intensive Care Medicine, Cochin University Hospital, Paris, France
| | - Jean-François Hardy
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France (NATA)
- Department of Anaesthesiology, Université de Montréal, Montreal, QC, Canada
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Kılıççı Ç, Polat M, Küçükbaş M, Şentürk MB, Karakuş R, Yayla Abide Ç, Bostancı Ergen E, Yenidede İ, Karateke A. Modified abdominal packing method in "near miss" patients with postpartum hemorrhages. Turk J Obstet Gynecol 2018; 15:159-164. [PMID: 30202625 PMCID: PMC6127472 DOI: 10.4274/tjod.79095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/26/2018] [Indexed: 12/02/2022] Open
Abstract
Objective: To describe a more effective abdominal packing method in patients with disseminated intravascular coagulation following peripartum hysterectomy due to postpartum hemorrhage (PPH). Materials and Methods: The present retrospective and descriptive study was conducted to document six cases with refractory pelvic bleeding who underwent a second surgery for PPH between January 2016 and December 2017 at İstanbul Zeynep Kamil Woman and Children Diseases Training and Research Hospital. Results: Karateke packing was performed to control intra-abdominal massive hemorrhages of five women who were referred to our clinic due to PPH who had undergone peripartum hysterectomy and hypogastric artery ligation but hemostasis could not be provided. In addition, a case of hypovolemic shock due to placenta percreta rupture in a woman who had also undergone an emergency hysterectomy and hypogastric artery ligation, which had failed. Hemostasis was provided in all patients. No method-related complication developed. Conclusion: Karateke packing is a very easy method to perform, it is more effective than the classic abdominal packing technique, with a low complication rate, and most importantly, life-saving in patients undergoing a peripartum hysterectomy due to PPH and thereafter experiencing diffuse hemorrhage.
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Affiliation(s)
- Çetin Kılıççı
- İstanbul Zeynep Kamil Woman and Children Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mesut Polat
- İstanbul Medeniyet University, Göztepe Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mehmet Küçükbaş
- İstanbul Medeniyet University, Göztepe Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mehmet Baki Şentürk
- İstanbul Zeynep Kamil Woman and Children Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Resul Karakuş
- İstanbul Zeynep Kamil Woman and Children Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Çiğdem Yayla Abide
- İstanbul Medeniyet University, Göztepe Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Evrim Bostancı Ergen
- İstanbul Zeynep Kamil Woman and Children Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - İlter Yenidede
- İstanbul Zeynep Kamil Woman and Children Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ateş Karateke
- İstanbul Medeniyet University, Göztepe Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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Bernède L, Hourbracq M, Madar H, Froeliger A, Matuizzi A, Sentilhes L. Spontaneous hemoperitoneum in pregnancy caused by a hepatocellular adenoma, accompanied by fetal death. Eur J Obstet Gynecol Reprod Biol 2018; 228:338. [PMID: 30082185 DOI: 10.1016/j.ejogrb.2018.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/13/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Bernède
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
| | - Mélissa Hourbracq
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Alizée Froeliger
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Aurélien Matuizzi
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
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