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Abouda HS, Marzouk SB, Boussarsar Y, Aloui H, Frikha H, Hammami R, Chennoufi B, Maghrebi H. Tourniquet on the low segment of the uterus reduces blood loss in postpartum hemorrhage during hysterectomy for placenta accreta: Old but gold. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100285. [PMID: 38351966 PMCID: PMC10862398 DOI: 10.1016/j.eurox.2024.100285] [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: 01/07/2024] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
Objectives To investigate the feasibility, safety, and efficiency after application of a cervical tourniquet during caesarian hysterectomy owing to placenta accreta. Study design It was a monocentric prospective observational study for 3 years. Patients were allocated into two group: Group Tourniquet: (TG) in which a cervical tourniquet was systematically applied during hysterectomy, control group (CG) when the caesarian hysterectomy was performed without. Results 20 patients in the TG and 23 patients in the CG. Tourniquet application significantly reduced per operative estimated blood loss volume (TG: 530 ± 135 vs 940 ± 120 ml in the CG, p = 0.0074), ΔHB (0.6 [0.3-1.9] vs 2.5[2.5-3.6] g/dl in the CG, p = 0.006) RBC transfusion requirements' (TG: 2 ± 1.7 vs 4.3 ± 2.1 units in the CG, p = 0.046) procedure duration (TG: 98 ± 21 vs 137 ± 33 min in the CG, p = 0.015), clotting disorders (TG: 1 (5%) vs 6 (26,1%) in the CG, p = 0.013) and the incidence of bladder wounds (TG: 1 (5%) vs 5 (21,7%) in the CG, p = 0.048). There was no significant difference regarding ICU transfer rate (TG: 16 (80%) vs 20 (86.9%) in the CG, p = 0.53) or length of stay (TG: 1.4 [2,3] vs 2.3 [1-4] days in the CG, p = 0.615) and digestive wound (TG: 0 vs 2 (8,7%) in the CG, p = 0.641). Conclusion In case of a radical management of placenta accreta. A strategy that involves the application of a cervical Tourniquet should be considered as a feasible, safe and above all efficient alternative to prevent blood spoliation.
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Affiliation(s)
- Hassine S. Abouda
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Sofiene B. Marzouk
- Department of Anesthesiology and Intensive Care, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunis, Tunisia
| | - Yecer Boussarsar
- Department of Anesthesiology and Intensive Care, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunis, Tunisia
| | - Haithem Aloui
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Hatem Frikha
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Rami Hammami
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Badis Chennoufi
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Hayen Maghrebi
- Department of Anesthesiology and Intensive Care, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunis, Tunisia
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Nieto Calvache AJ, Hidalgo A, López MC, Vergara-Galliadi LM, Nieto-Calvache AS. Placenta accreta spectrum in vulnerable population: How to provide care for pregnant refugees struggling to access affordable healthcare. J Matern Fetal Neonatal Med 2021; 35:5031-5034. [PMID: 33455510 DOI: 10.1080/14767058.2021.1874906] [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] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Placenta accreta spectrum (PAS) disorder is a serious condition that frequently requires special care in specialized centers. Migrant pregnant women face economic and social disadvantages that place them in situations of pervasive health disparities and, thus, poorer pregnancy outcomes can be expected. PURPOSE Describe the care of migrants without health insurance, affected by PAS and treated in a reference center for PAS. METHODS AND RESULTS The institutional registry of PAS in a private Latin American center was reviewed in search of migrant patients, identifying three patients without health insurance, with PAS, referred outside the traditional administrative channels, in the context of an inter-institutional collaboration program. CONCLUSION Migration imposes additional difficulties in the management of complex obstetric pathologies such as PAS. We recommend interinstitutional collaboration as a strategy to bring patients affected by PAS to experienced hospitals.
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Asherman syndrome and insufficient endometrial thickness: A hypothesis of integrated approach to restore the endometrium. Med Hypotheses 2019; 134:109521. [PMID: 31887722 DOI: 10.1016/j.mehy.2019.109521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/03/2019] [Accepted: 12/07/2019] [Indexed: 11/24/2022]
Abstract
Asherman syndrome consists in an acquired condition characterized by the development of fibrous intrauterine adhesions involving until two-thirds of the uterine cavity. Common signs of the syndrome are represented by alterations of regular menses, hypomenorrhea and amenorrhea. Moreover, women affected by Asherman syndrome, often struggle with fertility problems such as difficulty in spontaneous conceiving as well as complications including recurrent pregnancy loss and invasive placentation. The abnormality of the endometrial line consisting in insufficient thickness and/or endometrial trauma damaging the decidua basalis, are characteristic elements of the disease. Several studies have been conducted during the last ten years to find a solution restoring the regular endometrial line solving the fertility issue in Asherman women. Hormonal therapy as well as the use of stem cells seem to represent valid options to regenerate the endometrium opening a new scenario in the fertility treatment of these women. In this context, the presented study proposes an integrated approach to reach an adequate endometrial reconstitution and consequentially optimal fertility outcomes.
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Barinov SV, Tirskaya YI, Shamina IV, Ledovskikh IO, Atamanenko OJ. Placental blood flow and pregnancy outcomes in women with abnormal placental localization and absence of placental "migration". J Matern Fetal Neonatal Med 2019; 34:3496-3502. [PMID: 31736394 DOI: 10.1080/14767058.2019.1685973] [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: 10/25/2022]
Abstract
Aim: We investigated the arcuate artery blood flow in the region of the abnormally localized placenta in women who had undergone insertion of an obstetric pessary and were receiving micronized progesterone.Materials and methods: The study included 120 pregnant women with high perinatal risks and abnormal placental localization. The patients were randomized to receive the Arabin's pessary and vaginal micronized progesterone (Group A, n = 60) or vaginal micronized progesterone only (Group B, n = 60). Randomization was carried based on the order of hospital admission: odd patient numbers were allocated to Group A and even numbers to Group B. Patients underwent a series of ultrasound scans to evaluate the placental migration and presence of abnormal placental attachment. Depending on the results of the scan, study participants were divided into the following groups: (1) patients without placental migration: A1 (n = 23) and B1 (n = 42); and (2) patients with placental migration: A2 (n = 37) and B2 (n = 18). Women in subgroups A1 and B1 were further divided into the subgroups based on the presence of abnormal placental attachment: A1x (n = 5) and B1x (n = 12) with abnormal placental attachment; and A1O (n = 18) and B1O (n = 30) without the abnormal placental attachment.Conclusion: In patients with abnormal placental attachment, the resistance of blood flow in the arcuate arteries was significantly higher than in those with normal placental attachment. A significant increase in the blood flow resistance occurred between 24 and 28 weeks of gestation. The combined use of the obstetric pessary and vaginal micronized progesterone in women with abnormal placental localization helped maintain the resistivity index at low levels and reduce the rate of abnormal placental attachment by 1.3-fold (OR 0.694 (95% CI: 0.21-2.29)).
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Affiliation(s)
- S V Barinov
- Federal State Budget Institution of Higher Education, "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
| | - Y I Tirskaya
- Federal State Budget Institution of Higher Education, "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
| | - I V Shamina
- Federal State Budget Institution of Higher Education, "Omsk State Medical University" of the Russian Ministry of Health, Omsk, Russia
| | - I O Ledovskikh
- Perinatal Centre, Budget Healthcare Omsk Region Institution, Regional Clinical Hospital, Omsk, Russia
| | - O J Atamanenko
- Perinatal Centre, Budget Healthcare Omsk Region Institution, Regional Clinical Hospital, Omsk, Russia
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Nieto AJ, Echavarría MP, Carvajal JA, Messa A, Burgos JM, Ordoñez C, Benavidez JP, Mejía M, López L, Fernández PA, Escobar MF. Placenta accreta: importance of a multidisciplinary approach in the Colombian hospital setting. J Matern Fetal Neonatal Med 2018; 33:1321-1329. [PMID: 30153754 DOI: 10.1080/14767058.2018.1517328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: The management of patients with placenta accreta (PA) poses a challenge to health services. Although it may lead to devastating complications, its low incidence limits the development of expertize in all obstetric centers. We evaluated the results obtained from a multidisciplinary approach in patients with PA in a Latin American hospital.Methods: The study included patients with prenatal suspicion or intraoperative diagnosis of PA, before and after initiating a set of interdisciplinary and institutional interventions, with the aim of achieving better outcomes.Results: From December 2011 to December 2017, 62 patients with prenatally or intraoperatively suspected PA underwent surgery. The first 30 women (Group A), admitted until April 2016 and before any changes in the management protocol, had a longer hospital stay and surgery time, higher newborn hospitalization, and greater use of general anesthesia, compared to the 20 patients from Group B, who were admitted during the last 20 months of the observation period. A total of 12 women with late and intraoperative diagnosis, under no institutional protocol, showed greater blood loss and more frequent red blood cell transfusions.Conclusions: The expertize of the multidisciplinary team responsible for managing women with PA is associated with better clinical outcomes.
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Affiliation(s)
- Albaro José Nieto
- Tertiary Obstetric Unit, Department of Gynecology and Obstetrics, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Clinic for Placenta Accreta, Fundación Valle del Lili, Cali, Colombia
| | - María Paula Echavarría
- Tertiary Obstetric Unit, Department of Gynecology and Obstetrics, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Clinic for Placenta Accreta, Fundación Valle del Lili, Cali, Colombia
| | - Javier Andrés Carvajal
- Tertiary Obstetric Unit, Department of Gynecology and Obstetrics, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Clinic for Placenta Accreta, Fundación Valle del Lili, Cali, Colombia
| | - Adriana Messa
- Tertiary Obstetric Unit, Department of Gynecology and Obstetrics, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Clinic for Placenta Accreta, Fundación Valle del Lili, Cali, Colombia
| | - Juan Manuel Burgos
- Tertiary Obstetric Unit, Department of Gynecology and Obstetrics, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Clinic for Placenta Accreta, Fundación Valle del Lili, Cali, Colombia
| | - Carlos Ordoñez
- Department of Surgery, Fundación Valle del Lili, Cali, Colombia.,Clinic for Placenta Accreta, Fundación Valle del Lili, Cali, Colombia
| | - Juan Pablo Benavidez
- Tertiary Obstetric Unit, Department of Gynecology and Obstetrics, Fundación Valle del Lili, Cali, Colombia.,Clinic for Placenta Accreta, Fundación Valle del Lili, Cali, Colombia
| | - Mauricio Mejía
- Department of Radiology, Fundación Valle del Lili, Cali, Colombia.,Clinic for Placenta Accreta, Fundación Valle del Lili, Cali, Colombia
| | - Leidy López
- Department of Anesthesiology, Fundación Valle del Lili, Cali, Colombia.,Clinic for Placenta Accreta, Fundación Valle del Lili, Cali, Colombia
| | | | - María Fernanda Escobar
- Tertiary Obstetric Unit, Department of Gynecology and Obstetrics, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Clinic for Placenta Accreta, Fundación Valle del Lili, Cali, Colombia
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Morbidly Adherent Placenta: Its Management and Maternal and Perinatal Outcome. J Obstet Gynaecol India 2016; 67:42-47. [PMID: 28242967 DOI: 10.1007/s13224-016-0923-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/20/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The aim of the study was to identify the risk factors predisposing to morbidly adherent placenta and to study the different modes of management and the obstetric and neonatal outcome of these patients. METHODS This was a retrospective cum prospective observational study conducted in the Department of Obstetrics and Gynaecology in a tertiary care referral hospital in Mumbai from January 2012 to November 2014. RESULTS The incidence of morbidly adherent placenta was 1.32 per 1000 pregnancies with patient profile comprising second gravida in the age group 26-28 years; 90 % of the patients in this study had previous Caesarean section and co-existing placenta praevia was diagnosed in 63 %. Fifty-three per cent of the women delivered between 35 and 38 weeks and 40 % had elective deliveries. Caesarean section was the mode of delivery in 90 % of the patients. Prophylactic balloon placement in the internal iliac artery followed by classical Caesarean section, uterine artery embolization and post-operative methotrexate was done in 27 % which preserved the uterus and was associated the blood loss of 1000-2000 mL. CONCLUSION Antenatal diagnosis of morbidly adherent placenta allows for multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality.
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Li GT, Li GR, Li XF, Wu BP. Funnel compression suture: a conservative procedure to control postpartum bleeding from the lower uterine segment. BJOG 2015; 123:1380-5. [PMID: 26434751 DOI: 10.1111/1471-0528.13685] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 12/01/2022]
Affiliation(s)
- GT Li
- Department of Obstetrics and Gynaecology; China Meitan General Hospital; Beijing China
| | - GR Li
- Wangjing Hospital; China Academy of Chinese Medical Science; Beijing China
| | - XF Li
- Departments of Radiation Oncology; Peking University School of Oncology; Peking University Cancer Hospital; Beijing China
| | - BP Wu
- Department of Obstetrics and Gynaecology; China Meitan General Hospital; Beijing China
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Muñoz LA, Mendoza GJ, Gomez M, Reyes LE, Arevalo JJ. Anesthetic management of placenta accreta in a low-resource setting: a case series. Int J Obstet Anesth 2015; 24:329-34. [PMID: 26343175 DOI: 10.1016/j.ijoa.2015.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 05/04/2015] [Accepted: 05/31/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current recommendations for the anesthetic management of placenta accreta support a conservative approach with neuraxial anesthesia and uterine artery embolization. These are based on case series from experienced centers in developed countries. The aim of this study was to describe the anesthetic management of placenta accreta in a low-resource setting. METHODS A retrospective case note review was performed. From 1 August 2006 to 31 July 2011 placentas from cases of suspected placenta accreta were reassessed histologically to confirm the diagnosis. Patient charts were reviewed and information on anesthetic technique, monitoring, blood transfusion, maternal and fetal outcomes was extracted. RESULTS Thirty-nine cases were identified. Mean (± SD) maternal age was 33 ± 5.4 years. Hysterectomy was performed at the time of cesarean section in all cases. Thirty-four patients received neuraxial anesthesia, of whom 15 required conversion to general anesthesia. Invasive blood pressure monitoring was used in all patients and a central venous catheter was inserted in 33 cases. Complications associated with monitoring occurred in five patients. Median [IQR] blood loss was 2000 [1100-2700] mL and the median [IQR] number of units of red blood cell transfused was 2 [0-6]. Vasoactive medication was used in 14 patients and 15 patients were transferred to the intensive care unit postoperatively. No maternal or newborn deaths occurred. CONCLUSION A multidisciplinary approach can prove valuable when placenta accreta is suspected before delivery. In low-resource settings, lack of interventional radiology services and prenatal diagnostic capability may have an impact on anesthetic management in patients with placenta accreta. However, other than greater blood loss, our study demonstrated that good maternal and neonatal outcomes are possible in spite of limited resources.
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Affiliation(s)
- L A Muñoz
- Department of Anesthesiology, Fundación Universitaria de Ciencias de la Salud, Hospital de San Jose, Bogota, Colombia.
| | - G J Mendoza
- Department of Anesthesiology, Fundación Universitaria de Ciencias de la Salud, Hospital de San Jose, Bogota, Colombia
| | - M Gomez
- Department of Critical Care, Hospital de San Jose, Bogota, Colombia
| | - L E Reyes
- Department of Anesthesiology, Fundación Universitaria de Ciencias de la Salud, Hospital de San Jose, Bogota, Colombia
| | - J J Arevalo
- Department of Anesthesiology, Fundación Universitaria de Ciencias de la Salud, Hospital de San Jose, Bogota, Colombia
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Singh R, Pradeep Y. Maternal and neonatal outcomes in morbidly adherent placenta: a developing country experience. Trop Doct 2015; 45:183-7. [PMID: 25979844 DOI: 10.1177/0049475515585639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Morbid adherent placenta, a severe pregnancy complication, is associated with massive obstetrical haemorrhage and high maternal mortality. Antenatal diagnosis and meticulous multidisciplinary planning at delivery is crucial for optimal outcome. We aim to identify the maternal and neonatal outcome in women with morbid adherent placenta. METHOD It was a retrospective evaluation of cases of clinically suspected and/or histologically confirmed morbid adherent placenta over a 1-year period. RESULTS The incidence of morbid adherent placenta was 1 per 306 deliveries. Previous Caesarean section with placenta praevia was the commonest risk factor. Among all, 71.4% had no antenatal care. Of all, 38.9% women needed transfer to critical care. There were five (23.8%) maternal deaths. Of the 21 neonates, four were stillborn, nine needed NICU transfer and eight had an Apgar score of 9 at 5 min of birth. CONCLUSION Morbid adherent placenta is associated with poor maternal and neonatal outcome.
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Affiliation(s)
- Renu Singh
- Associate Professor, Department of Obstetrics & Gynecology, King George's Medical University, Lucknow, India
| | - Yashodhara Pradeep
- Professor, Department of Obstetrics & Gynecology, King George's Medical University, Lucknow, India
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Bajwa SJS, Bajwa SK. Critical care in obstetrics: Essentiality, initiatives, and obstacles in Indian scenario. J Anaesthesiol Clin Pharmacol 2014; 30:459-61. [PMID: 25425767 PMCID: PMC4234778 DOI: 10.4103/0970-9185.142798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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