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Takahashi M, Takeda J, Haneda S, Ishii S, Shinohara M, Yoshida E, Sato A, Makino S, Itakura A. "Step-by-Step" Minimally Invasive Hemostatic Technique Using Intrauterine Double-Balloon Tamponade Combined with Uterine Isthmus Vertical Compression Suture for the Control of Placenta Accreta and Severe Atonic Hemorrhage during a Cesarean Section. Surg J (N Y) 2021; 7:e216-e221. [PMID: 34466659 PMCID: PMC8390297 DOI: 10.1055/s-0041-1733990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
A sudden onset of postpartum hemorrhage (PPH) during a cesarean delivery requires urgent hemostasis procedures, such as the B-Lynch, Hayman, or double-vertical compression sutures, when bimanual compression, uterotonic agent administration, and intrauterine balloon tamponade had failed to achieve sufficient hemostasis. However, after invasive hemostatic procedures, postoperative complications, including subsequent synechiae and infection followed by ischemia, have been reported to occur even in successful cases. To avoid these complications, we devised and performed a minimally invasive combined technique based on a “step-by-step” minimally invasive hemostatic protocol for a case of placenta accreta and severe atonic hemorrhage during a cesarean delivery. A nullipara woman with a history of systemic lupus erythematosus and treatment with prednisolone and tacrolimus underwent a cesarean section because of a nonreassuring fetal status. Severe atonic hemorrhage and placenta accreta were observed which did not respond to bimanual compression and uterotonics. Because severe uterine atony and continuous bleeding from the placental attachment area were observed even with intrauterine balloon tamponade, vertical compression sutures were placed in the uterine isthmus. However, severe uterine atony and atonic bleeding from the uterine corpus persisted; thus, a second balloon was inserted into the uterine corpus. Hemostasis was accomplished with a combination of isthmus vertical compression sutures and double balloons which is a less-invasive approach than existing compression techniques. No complications related to these procedures were observed. This step-by-step minimally invasive hemostatic technique has the potential to control PPH with less complications, especially in immunocompromised patients.
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Affiliation(s)
- Masaya Takahashi
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Sumie Haneda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Sumire Ishii
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mitsuko Shinohara
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Emiko Yoshida
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Anna Sato
- 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
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Kondoh E, Chigusa Y, Ueda A, Mogami H, Mandai M. Novel intrauterine balloon tamponade systems for postpartum hemorrhage. Acta Obstet Gynecol Scand 2019; 98:1612-1617. [DOI: 10.1111/aogs.13692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/23/2019] [Accepted: 07/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Eiji Kondoh
- Department of Gynecology and Obstetrics Kyoto University Kyoto Japan
| | | | - Akihiko Ueda
- Department of Gynecology and Obstetrics Kyoto University Kyoto Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics Kyoto University Kyoto Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics Kyoto University Kyoto Japan
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Ikeda A, Kondoh E, Chigusa Y, Mogami H, Kameyama Nakao K, Kido A, Horie A, Baba T, Hamanishi J, Mandai M. Novel subtype of atonic postpartum hemorrhage: dynamic computed tomography evaluation of bleeding characteristics and the uterine cavity. J Matern Fetal Neonatal Med 2019; 33:3286-3292. [PMID: 30651015 DOI: 10.1080/14767058.2019.1571033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Uterine atony is the leading cause of severe postpartum hemorrhage (PPH); however, the underlying cause of intractable atonic PPH unresponsive to conventional treatments (such as uterotonics and intrauterine balloon tamponade) remains unclear.Objectives: The aim of this study was to investigate whether intractable atonic PPH is associated with the type of bleeding (arterial or nonarterial) and its location, along with variations in the size and shape of the uterine cavity after delivery.Study design: This retrospective study included women who had undergone a dynamic computed tomography (CT) scan for the management of severe PPH at Kyoto University Hospital between April 2011 and March 2017. Patients' electronic medical records were reviewed, and relevant clinical information was collected. The presence of contrast extravasation (CE) on CT images in the early phase (40 s) was regarded as active arterial bleeding. Bleeding sites and size of the uterine cavity were evaluated using an xyz coordinate system. The size of the uterine cavity was compared between groups with CE into the upper and lower parts of the uterine body.Results: Of the 60 women assessed for eligibility, 30 were included in the current analysis. Contrast extravasation was detected in 19 women, with 14 showing CE in the early phase. The presence of CE in the early phase was significantly associated with the need for transarterial embolization (Fisher's exact test, p = .0017). The upper and lower parts of the uterine cavity were 97.4 ± 2.7 mm (mean ± standard error of the mean) and 87.2 ± 3.5 mm in length, respectively. The maximum anteroposterior diameters of the upper and lower parts of the uterine cavity were 23.1 ± 2.6 and 76.0 ± 3.0 mm, respectively, and the largest transverse diameters were 67.3 ± 1.9 and 81.1 ± 2.3 mm, respectively. The group that showed CE into the upper uterine cavity had significantly larger qualitative parameters of the upper uterine cavity compared to the group with CE into the lower uterine cavity. The gate from the lower uterine cavity toward the upper uterine cavity was narrow (anteroposterior diameter of 22.6 ± 2.0 mm, transverse diameter of 40.7 ± 3.3 mm), and the intrauterine balloon was always found in the lower uterine cavity on the CT scan. The upper uterine body was characterized by a flat oval-shaped cavity (xy plane), thick uterine wall, and lack of uniformity among bleeding sites (z = 62.4 ± 14.8 mm). In contrast, the lower uterine cavity was a circular shape (xy plane) with thin walls, and bleeding sites were located at lateral sides around the level of the internal os (z = -18.8 ± 4.9 mm).Conclusions: Atonic PPH has a significant subtype, named "PRACE," which is characterized by PPH, resistance to treatment, and arterial CE. The need for embolization can be predicted by the presence of arterial bleeding and its location, along with the shape of the uterine cavity.
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Affiliation(s)
- Asami Ikeda
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | | | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Kyoko Kameyama Nakao
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Akihito Horie
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Tsukasa Baba
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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Sato M, Kondoh E, Iwao T, Hiragi S, Okamoto K, Tamura H, Mogami H, Chigusa Y, Kuroda T, Mandai M, Konishi I, Kato G. Nationwide survey of severe postpartum hemorrhage in Japan: an exploratory study using the national database of health insurance claims. J Matern Fetal Neonatal Med 2018; 32:3537-3542. [PMID: 29656684 DOI: 10.1080/14767058.2018.1465921] [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] [Indexed: 10/17/2022]
Abstract
Aim: The aim of this study was to investigate epidemiological and clinical aspects of severe postpartum hemorrhage (PPH) in Japan. Methods: We used national health insurance claims from 2011 to 2014 provided by the Ministry of Health, Labour and Welfare. The data included randomly selected claims that covered 10% of all inpatients in October, a so-called sampling dataset (covering 1/120 inpatients per year). We extracted claims for transfused blood, and further narrowed down the claims by names of diseases linked to PPH. As most referral obstetric facilities have adopted the diagnosis procedure combination (DPC)-based payment system while small-scale obstetric facilities have not (non-DPC facilities), the claims were also analyzed separately for DPC and non-DPC facilities. We assessed the incidence and causes of PPH, transfusion volume of red blood cells (RBC) and fresh frozen plasma (FFP), and surgical hemostatic management. Results: The number of PPH cases that required blood transfusion in the sampling dataset was 29, 29, 32, and 36 in 2011, 2012, 2013, and 2014, respectively. The leading cause of PPH was uterine atony followed by placental abruption. Although no specific trends were observed for the volume of transfused RBC (1467 ± 234 ml in 2014), there was a steady increase in the rate of FFP utilization in non-DPC facilities from 37% to 79% over the 4-year sampling period. Intrauterine balloon tamponade emerged in 2014. Conclusion: This nationwide survey indicates that the annual incidence of severe PPH is increasing. Furthermore, FFP has become more prevalent in small-scale obstetric facilities.
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Affiliation(s)
- Mai Sato
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Eiji Kondoh
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Tomohide Iwao
- b Department of Medical Informatics , Kyoto University , Kyoto , Japan
| | - Shusuke Hiragi
- b Department of Medical Informatics , Kyoto University , Kyoto , Japan
| | - Kazuya Okamoto
- b Department of Medical Informatics , Kyoto University , Kyoto , Japan
| | - Hiroshi Tamura
- b Department of Medical Informatics , Kyoto University , Kyoto , Japan
| | - Haruta Mogami
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Yoshitsugu Chigusa
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Tomohiro Kuroda
- b Department of Medical Informatics , Kyoto University , Kyoto , Japan
| | - Masaki Mandai
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Ikuo Konishi
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Genta Kato
- c Solutions Center for Health Insurance Claims, Kyoto University Hospita , Kyoto , Japan
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Kanbayashi S, Kondoh E, Suginami K, Io S, Hamanishi J, Konishi I. Successful management of intraoperative haemorrhage during emergency cervical cerclage using balloon tamponade. J OBSTET GYNAECOL 2017; 37:523-524. [DOI: 10.1080/01443615.2016.1268581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shota Kanbayashi
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Koh Suginami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Shingo Io
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Ikuo Konishi
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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