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Shi X, Guo J, Saravelos S, Huang X, Xia E, Feng L, Li TC. The use of intrauterine balloon therapy in reproductive medicine and surgery: a guidance for practice. HUM FERTIL 2023; 26:742-756. [PMID: 37778373 DOI: 10.1080/14647273.2023.2255745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 10/03/2023]
Abstract
The use of balloon therapy in obstetric practice especially in postpartum haemorrhage (PPH) is well established and has recently been reviewed. However, little attention has been drawn regarding the use of intrauterine balloon (IUB) in gynaecological practice. This study focuses on the various usage of IUB in gynaecological practice. An electronic literature search through Medline, EMBASE and Clinicaltrial.gov from inception to August 2022 was conducted. The study focuses on the three following areas: (1) Indications: prevention and removal of intrauterine adhesions, management of ectopic pregnancy, facilitation of endoscopic surgery and other clinical usages; (2) Practical aspects of balloon therapy including ultrasound guidance, choice of balloon, inflation volume, duration of balloon therapy; and (3) Potential complications including pain, infection, uterine rupture and how they can be avoided. IUB therapy is a simple, inexpensive and effective method that can be applied in various gynaecological conditions ranging from IUA to intrauterine haemorrhage. Complications are rare, but in most cases can be avoided with correct use.
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Affiliation(s)
- Xiaoyu Shi
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, The Fifth Clinical Medical College, Capital Medical University, Beijing, P. R. China
| | - Jun Guo
- Department of Obstetrics and Gynecology, Beijing Tongren Hospital, The Fourth Clinical Medical College, Capital Medical University, Beijing, P. R. China
| | - Sotirios Saravelos
- Department of Obstetrics and Gynaecology, IVF Unit, Hammersmith Hospital, Imperial College London, London, UK
| | - Xiaowu Huang
- Department of Hysteroscopic Centre, Fuxing Hospital, Capital Medical University, Beijing, P. R. China
| | - Enlan Xia
- Department of Hysteroscopic Centre, Fuxing Hospital, Capital Medical University, Beijing, P. R. China
| | - Limin Feng
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, The Fifth Clinical Medical College, Capital Medical University, Beijing, P. R. China
| | - Tin-Chiu Li
- Department of Hysteroscopic Centre, Fuxing Hospital, Capital Medical University, Beijing, P. R. China
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2
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Damiani GR, Dellino M, Cascardi E, Xuamin H, Di Gennaro D, Vimercati A, Vitagliano A, Malvasi A, loizzi V, Paniga C, Lanteri L, Alfonso R, Cicinelli E, Pellegrino A. Uterine venous malformations in the puerperium: 2 Atypical cases and literature review. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100220. [PMID: 37636521 PMCID: PMC10450833 DOI: 10.1016/j.eurox.2023.100220] [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: 05/13/2023] [Accepted: 07/29/2023] [Indexed: 08/29/2023] Open
Abstract
Uterine arteriovenous malformations (AVMs) is a rare but high-risk cause of uterine bleeding. The clinical management of this condition is challenging, as the ultrasound picture can sometimes be unambiguously interpreted. Moreover, in the puerperium in which acquired AVMs are most frequently formed, it is necessary to discuss the correct management in a multidisciplinary and personalized manner. We present two cases of AVMs developing in the puerperium, both with a vaginal delivery and spontaneous and complete secondment. The symptom of onset was an episode of bright red blood loss in the puerperium, on the 14th and 21st postpartum days, respectively. Transvaginal ultrasound showed a hypervascularized lesion in the myometrium with turbulent vascular flow, confirmed by transabdominal ultrasound and angiography. To date, there are no guidelines on the management of MAVs. In our cases we opted for a conservative approach, in order to preserve the fertility of the patient. These experiences reported have the purpose of enriching a literature still sparse on the subject and in the future to be able to represent a fulcrum for official recommendations.
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Affiliation(s)
- Gianluca Raffaello Damiani
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Miriam Dellino
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - He Xuamin
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
- San Raffaele Hospital, Milan,Italy
| | - Daniele Di Gennaro
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonella Vimercati
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Amerigo Vitagliano
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonio Malvasi
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Vera loizzi
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", 70124 Bari, Italy
- Oncology Unit IRCSS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Cristiana Paniga
- University of Milan-Biccocca,Department of Medicine and Surgery, Milan, Italy
| | - Laura Lanteri
- University of Milan-Biccocca,Department of Medicine and Surgery, Milan, Italy
| | - Raffaello Alfonso
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy
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Purandare CN, Nazareth AK, Ryan G, Purandare NC. Role of Balloon Tamponade as a Therapeutic Non-Surgical Tool in Controlling Obstetric and Gynecological Hemorrhage in Low-Resource Countries. J Obstet Gynaecol India 2022; 72:285-290. [PMID: 35923509 PMCID: PMC9339450 DOI: 10.1007/s13224-022-01662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/01/2022] [Indexed: 10/18/2022] Open
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4
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Nagase Y, Matsuzaki S, Kawanishi Y, Nakagawa S, Kakigano A, Takiuchi T, Mimura K, Tomimatsu T, Endo M, Kimura T. Efficacy of Prophylactic Antibiotics in Bakri Intrauterine Balloon Placement: A Single-Center Retrospective Analysis and Literature Review. AJP Rep 2020; 10:e106-e112. [PMID: 32206439 PMCID: PMC7082208 DOI: 10.1055/s-0040-1708487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 11/15/2019] [Indexed: 11/07/2022] Open
Abstract
Objective Bakri intrauterine balloon (BIUB) placement is an effective treatment for postpartum hemorrhage (PPH). This study aims to evaluate the risk of infection during BIUB placement. Study Design Data for all deliveries ( n = 2,144) at our institution between January 2014 and March 2018 were retrospectively reviewed. Patients diagnosed with PPH ( n = 758) were included in our analysis, further divided into BIUB ( n = 80) and non-BIUB groups ( n = 678), and subdivided into vaginal delivery (VD), elective cesarean delivery (CD), and emergency CD groups. Postpartum endometritis rate was compared in each group. A single dose of prophylactic antibiotics was administered for BIUB placement in the VD group. In the CD groups, antibiotics were administered preoperatively once, and no additional antibiotics for BIUB placement were administered. To obtain an antibiotics administration protocol to be applied during BIUB placement, we electronically searched the PubMed and Scopus databases. Results No significant differences were observed in endometritis rates between BIUB and non-BIUB groups of all groups. In the literature review, of 27 suitable publications identified, multiple doses of antibiotics were administered in 17 (62.9%) studies and none investigated the efficacy of a protocol for antibiotic. Conclusion Our protocol might be effective and sufficient in preventing postpartum BIUB placement-related endometritis.
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Affiliation(s)
- Yoshikazu Nagase
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoko Kawanishi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Nakagawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Children and Women's Health, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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Takeda J, Makino S, Hirai C, Shimanuki Y, Inagaki T, Itakura A, Takeda S. Assessment of extravasation on ruptured uterine artery pseudoaneurysm using contrast-enhanced ultrasonography during uterine balloon tamponade. J Int Med Res 2019; 48:300060519893166. [PMID: 31856625 PMCID: PMC7645375 DOI: 10.1177/0300060519893166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective Contrast-enhanced ultrasonography (CEU) has been used in critical trauma situations to visualize extravasation; however, its use is limited in the field of obstetrics. Cases of ruptured uterine artery pseudoaneurysm (UAP) were analyzed to clarify the efficacy to CEU during uterine balloon tamponade. Methods Cases of ruptured UAP diagnosed at a teaching university hospital from January 2015 to December 2017 were retrospectively analyzed. UAP was diagnosed using color Doppler ultrasonography. Extravasation was identified using computed tomography and double checked using CEU with an intravenously administered contrast agent (Sonazoid; Daiichi Sankyo Company, Ltd., Tokyo, Japan) and an ultrasound instrument (HI VISION Preirus; Hitachi Aloka Medical, Ltd., Tokyo, Japan). A balloon was then inserted into the uterine cavity and inflated at the point of bleeding until extravasation ceased. Results Three patients exhibited ruptured UAP during the study period. Bleeding points were successfully identified using CEU in all cases, and hemostasis was achieved using uterine balloon tamponade. Obliteration of UAP was confirmed using magnetic resonance imaging, and no patients developed recurrent UAP or any complications. Conclusion CEU can be used at the bedside to promptly diagnose ruptured UAP. Moreover, it precisely facilitates balloon compression at the point of bleeding.
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Affiliation(s)
- Jun Takeda
- Jun Takeda, Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
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6
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Abstract
Hysteroscopy is performed to view and treat pathology within the uterine cavity and endocervix. Diagnostic hysteroscopy allows visualization of the endocervical canal, endometrial cavity, and fallopian tube ostia. Operative hysteroscopy incorporates the use of mechanical, electrosurgical, or laser instruments to treat intracavitary pathology and perform hysteroscopic sterilization procedures. Selection of a distending medium requires consideration of the advantages, disadvantages, and risks associated with various media as well as their compatibility with electrosurgical or laser energy. A preoperative consultation allows the patient and physician to discuss the hysteroscopic procedure, weigh its inherent risks and benefits, review the patient's medical history for any comorbid conditions, and exclude pregnancy. Known pregnancy, genital tract infections, and active herpetic infection are contraindications to hysteroscopy. The most common perioperative complications associated with operative hysteroscopy are hemorrhage, uterine perforation, and cervical laceration. The procedure is minimally invasive and can be used with a high degree of safety.
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7
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Vilos AG, Oraif A, Machado M, Abu-Rafea B, Vilos GA. Resolution of Uterine Arteriovenous Malformation and Maintenance of Reproduction in 20 Women Treated with a GnRH Agonist Concomitantly with an Aromatase Inhibitor and Tranexamic Acid. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:772-781. [DOI: 10.1016/j.jogc.2018.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 10/27/2022]
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8
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Dyne PL, Miller TA. The Patient with Non-Pregnancy-Associated Vaginal Bleeding. Emerg Med Clin North Am 2019; 37:153-164. [PMID: 30940364 DOI: 10.1016/j.emc.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abnormal uterine bleeding (AUB) unrelated to pregnancy affects 20% to 30% of women at some point in life and is a common emergency department (ED) and urgent care (UC) presentation. AUB is a complex condition with extensive terminology, broad differential diagnosis, and numerous treatment options, yet few published evidence-based guidelines. In the ED or UC setting most affected patients are often more frustrated than acutely ill. These factors can make for a challenging patient encounter in the EC/UC setting. This article reviews acute and chronic AUB in the nonpregnant patient and suggests a simplified approach for its evaluation and management.
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Affiliation(s)
- Pamela L Dyne
- UCLA-OV Emergency Medicine, Olive View-UCLA Department of Emergency Medicine, 14445 Olive View Drive, North Annex, Sylmar, CA 91342, USA.
| | - Teri Anne Miller
- UCLA-OV Emergency Medicine, UCLA Department of Emergency Medicine, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024, USA
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9
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Abstract
Management of heavy menstrual bleeding (HMB) in a woman with a history of thrombosis, or who is otherwise at high risk of thrombosis, or who takes medications for anticoagulation can present a challenge to health care providers. The goal of treating HMB is to reduce menstrual blood loss. First-line therapy is typically hormonal, and hormonal therapy can be contraindicated in women with a history of thrombosis unless they are on anticoagulation. As 70% of women on anticoagulation experience HMB, successful management of HMB may involve a modification in the anticoagulation or antiplatelet regimen, hormonal therapy tailored to the patient's situation, and/or surgical therapy.
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10
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Jegaden M, Scetbun E, Gaudu S, Fernandez H, Vigoureux S. A Lost Balloon-The Interest of a Systematic Ultrasonographyafter a Postabortion Hemorrhage. J Minim Invasive Gynecol 2019; 26:997-998. [PMID: 30708119 DOI: 10.1016/j.jmig.2019.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/20/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Margaux Jegaden
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (Drs. Jegaden, Scetbun, Gaudu, Fernandez, and Vigoureux)
| | - Elsa Scetbun
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (Drs. Jegaden, Scetbun, Gaudu, Fernandez, and Vigoureux)
| | - Sophie Gaudu
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (Drs. Jegaden, Scetbun, Gaudu, Fernandez, and Vigoureux)
| | - Herve Fernandez
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (Drs. Jegaden, Scetbun, Gaudu, Fernandez, and Vigoureux); Faculté de Médecine Paris-Sud, Université Paris-Sud, Le Kremlin-Bicêtre, France (Drs. Fernandez and Vigoureux); CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Institut national de la santé et de la recherche médicale, Villejuif, France (Drs. Fernandez and Vigoureux)
| | - Solène Vigoureux
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (Drs. Jegaden, Scetbun, Gaudu, Fernandez, and Vigoureux); Faculté de Médecine Paris-Sud, Université Paris-Sud, Le Kremlin-Bicêtre, France (Drs. Fernandez and Vigoureux); CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Institut national de la santé et de la recherche médicale, Villejuif, France (Drs. Fernandez and Vigoureux)..
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Takeda J, Makino S, Hirai C, Shimanuki Y, Inagaki T, Itakura A, Takeda S. Long-term uterine balloon tamponade for treatment and obliteration of ruptured uterine pseudoaneurysm. Taiwan J Obstet Gynecol 2018; 57:329-331. [PMID: 29880159 DOI: 10.1016/j.tjog.2018.04.001] [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] [Accepted: 07/25/2017] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE Rupture of uterine artery pseudoaneurysm (UAP) is a life-threatening event after childbirth. Hysterectomy or uterine arterial embolization was often needed for hemostasis. However, such procedures may cause severe morbidities for these women. To estimate the efficacy of uterine balloon tamponade (UBT) for controlling ruptured UAP bleeding, a retrospective analysis in a single teaching hospital was performed. MATERIALS AND METHODS We reviewed the medical record of Juntendo University Hospital in 2015. All the women diagnosed with UAP were recruited to this study and management for UAP was investigated. RESULTS Three women were treated with UBT for ruptured UAP. All cases achieved hemostasis. One case had recurrent UAP after 24 h of UBT, and was retreated with UBT for a longer duration. The UAP was obliterated after more than 2 days of UBT in all cases. CONCLUSION UBT has potential as a therapeutic technique not only for treatment of a ruptured UAP but also for obliteration of a UAP.
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Affiliation(s)
- Jun Takeda
- 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
| | - Chihiro Hirai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yota Shimanuki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tetsunori Inagaki
- 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
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Innovative Uses of Condom Uterine Balloon Tamponade for Postpartum Hemorrhage in India and Tanzania. Case Rep Obstet Gynecol 2018; 2018:4952048. [PMID: 29967704 PMCID: PMC6008944 DOI: 10.1155/2018/4952048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/07/2018] [Indexed: 01/04/2023] Open
Abstract
Background Postpartum hemorrhage is the most common cause of maternal deaths worldwide, the majority of which occur in low-resource settings. Uterine balloon tamponade (UBT) is an effective method of addressing uncontrolled postpartum hemorrhage (PPH) from uterine atony; however, UBT devices are often not affordable. We report on three novel uses of an ultra-low-cost condom uterine balloon tamponade (ESM-UBT) device. Cases ESM-UBT devices were used in innovative ways to arrest severe uncontrolled pregnancy-related hemorrhage among three women in India and Tanzania. The first had sustained deep vaginal lacerations, the second a cervical pregnancy, and the third a complete molar pregnancy. Conclusion The ESM-UBT device may be useful for control of obstetric hemorrhage caused by complex vaginal tears as well as cervical and molar pregnancies.
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13
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Khan ES, Basharat A. Successful use of balloon tamponade in the management of postpartum hemorrhage in a case of bicornuate uterus. SAGE Open Med Case Rep 2018; 6:2050313X18776174. [PMID: 29796270 PMCID: PMC5960844 DOI: 10.1177/2050313x18776174] [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: 11/14/2017] [Accepted: 04/16/2018] [Indexed: 11/15/2022] Open
Abstract
Worldwide 50%-70% of all cases of maternal morbidity have been attributed to postpartum hemorrhage. This report discusses a case of bicornuate uterus in a term pregnancy. The delivery was by cesarean section, which was followed by massive postpartum hemorrhage, managed successfully with balloon tamponade. This is the second reported case of successful management of post partum hemorrhage in a bicornuate uterus with balloon tamponade. A 22-year-old primigravida at 39 weeks of gestational age presented with vaginal leaking of clear fluid. Cesarean section was done due to meconium stained liquor in early labor; with an incidental finding of bicornuate uterus followed by massive postpartum hemorrhage managed successfully with balloon tamponade. The use of uterine balloon tamponade as an effective method to control postpartum hemorrhage has been studied extensively, but use in cases of hemorrhage associated with uterine malformations has not been reported much in literature. Use of uterine balloon tamponade in case of uterine malformations has been highlighted in our case as an effective non-surgical method to control hemorrhage.
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Affiliation(s)
- Erum Saleem Khan
- Department of Obstetrics & Gynecology, The Aga Khan University Hospital, Karachi, Pakistan
- Erum Saleem Khan, Department of Obstetrics & Gynecology, 515/516, Goldstreet Aga Khan Hospital for Women, Garden, 74800 Karachi, Pakistan.
| | - Ayesha Basharat
- Department of Obstetrics and Gynecology, Al Nafees Medical College & Hospital, Isra University, Islamabad, Pakistan
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14
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Herrick T, Mvundura M, Burke TF, Abu-Haydar E. A low-cost uterine balloon tamponade for management of postpartum hemorrhage: modeling the potential impact on maternal mortality and morbidity in sub-Saharan Africa. BMC Pregnancy Childbirth 2017; 17:374. [PMID: 29132342 PMCID: PMC5683546 DOI: 10.1186/s12884-017-1564-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/06/2017] [Indexed: 11/16/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is the leading cause of maternal deaths worldwide. This study sought to quantify the potential health impact (morbidity and mortality reductions) that a low-cost uterine balloon tamponade (UBT) could have on women suffering from uncontrolled PPH due to uterine atony in sub-Saharan Africa. Methods The Maternal and Neonatal Directed Assessment of Technology (MANDATE) model was used to estimate maternal deaths, surgeries averted, and cases of severe anemia prevented through UBT use among women with PPH who receive a uterotonic drug but fail this therapy in a health facility. Estimates were generated for the year 2018. The main outcome measures were lives saved, surgeries averted, and severe anemia prevented. Results The base case model estimated that widespread use of a low-cost UBT in clinics and hospitals could save 6547 lives (an 11% reduction in maternal deaths), avert 10,823 surgeries, and prevent 634 severe anemia cases in sub-Saharan Africa annually. Conclusions A low-cost UBT has a strong potential to save lives and reduce morbidity. It can also potentially reduce costly downstream interventions for women who give birth in a health care facility. This technology may be especially useful for meeting global targets for reducing maternal mortality as identified in Sustainable Development Goal 3.
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Affiliation(s)
- Tara Herrick
- PATH, Market Dynamics, 2201 Westlake Ave, Suite 200, Seattle, WA, 98121, USA.
| | - Mercy Mvundura
- PATH, Market Dynamics, 2201 Westlake Ave, Suite 200, Seattle, WA, 98121, USA
| | - Thomas F Burke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
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15
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How I treat heavy menstrual bleeding associated with anticoagulants. Blood 2017; 130:2603-2609. [PMID: 29092828 DOI: 10.1182/blood-2017-07-797423] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/24/2017] [Indexed: 12/28/2022] Open
Abstract
Anticoagulant-associated heavy menstrual bleeding (HMB) is an underrecognized but not uncommon problem in clinical practice. Premenopausal women should be advised of the potential effect of anticoagulant therapy on menstrual bleeding at the time of treatment initiation. Consequences of HMB should be assessed and treated on an ongoing basis. In the acute setting, the decision to withhold anticoagulants is based on an individual patient's risk of thrombosis and the severity of the bleeding. For women who require long-term anticoagulation, a levonorgestrel intrauterine system, tranexamic acid (during menstrual flow), high-dose progestin-only therapy, or combined hormonal contraceptives are effective for controlling HMB. The risk of thrombosis during anticoagulant therapy with these treatments is not well studied but is likely to be low. Selection of type of hormonal therapy is based on patient preference, other indications for and contraindications to therapy, adverse effect profile, and ongoing thrombotic risk factors. Women who do not respond to medical treatment or who do not wish to retain their fertility should be considered for surgical management.
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16
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Prise en charge des léiomyomes utérins. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S550-S576. [PMID: 28063565 DOI: 10.1016/j.jogc.2016.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Maher MA, Abdelaziz A. Comparison between two management protocols for postpartum hemorrhage during cesarean section in placenta previa: Balloon protocol versus non-balloon protocol. J Obstet Gynaecol Res 2016; 43:447-455. [PMID: 27987342 DOI: 10.1111/jog.13227] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/28/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mohammad Ahmed Maher
- Department of Obstetrics and Gynecology, Faculty of Medicine; Menoufia University; Shebin-Elkom Egypt
- Al-Hayat National Hospital; Khamis-Mushait Saudi Arabia
| | - Ahmed Abdelaziz
- Department of Obstetrics and Gynecology, Faculty of Medicine; Ain-shams University; Cairo Egypt
- Armed Forces Hospital North-West Region; Tabouk Saudi Arabia
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James AH. Heavy menstrual bleeding: work-up and management. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:236-242. [PMID: 27913486 PMCID: PMC6142441 DOI: 10.1182/asheducation-2016.1.236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Heavy menstrual bleeding (HMB), which is the preferred term for menorrhagia, affects ∼90% of women with an underlying bleeding disorder and ∼70% of women on anticoagulation. HMB can be predicted on the basis of clots of ≥1 inch diameter, low ferritin, and "flooding" (a change of pad or tampon more frequently than hourly). The goal of the work-up is to determine whether there is a uterine/endometrial cause, a disorder of ovulation, or a disorder of coagulation. HMB manifest by flooding and/or prolonged menses, or HMB accompanied by a personal or family history of bleeding is very suggestive of a bleeding disorder and should prompt a referral to a hematologist. The evaluation will include the patient's history, pelvic examination, and/or pelvic imaging, and a laboratory assessment for anemia, ovulatory dysfunction, underlying bleeding disorder, and in the case of the patient on anticoagulation, assessment for over anticoagulation. The goal of treatment is to reduce HMB. Not only will the treatment strategy depend on whether there is ovulatory dysfunction, uterine pathology, or an abnormality of coagulation, the treatment strategy will also depend on the age of the patient and her desire for immediate or long-term fertility. Hemostatic therapy for HMB may serve as an alternative to hormonal or surgical therapy, and may even be life-saving when used to correct an abnormality of coagulation.
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Affiliation(s)
- Andra H James
- Department of Obstetrics and Gynecology, Duke University, Durham, NC
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The fertility sparing management of postpartum hemorrhage: A series of 47 cases of Bakri balloon tamponade. Taiwan J Obstet Gynecol 2016; 54:232-5. [PMID: 26166332 DOI: 10.1016/j.tjog.2014.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the success rate of Bakri balloon tamponade (BBT) for managing postpartum hemorrhage (PPH), intractable to conservative medical treatment, as a fertility sparing intervention. MATERIALS AND METHODS We evaluated 47 women treated with BBT who had severe postpartum hemorrhage and uncontrollable bleeding due to failed treatment with uterotonic agents. The main outcome measure was successful management and preservation of the uterus. RESULTS Forty-seven women were identified for BBT treatment due to severe PPH. BBT was used to successfully manage hemorrhage in 43 patients, and there was no need for hysterectomy. Four patients required an additional surgical procedure. Of the four failures, a subtotal hysterectomy was performed in two patients, and the other two patients underwent a total hysterectomy. The overall success rate was 91.4%, which was comparable to rates reported earlier. The main cause of PPH was uterine atony (43%). CONCLUSION Uterine preservation is an important issue when managing PPH. BBT is an effective, easy to use, and safe procedure for massive PPH that can minimize recourse to hysterectomy after failed medical treatment.
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Bhoil R, Raghuvanshi V, Basavaiah S. A case of congenital uterine arterio-venous malformation managed by hysterectomy. Pol J Radiol 2015; 80:202-5. [PMID: 25922626 PMCID: PMC4408870 DOI: 10.12659/pjr.893299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 01/11/2015] [Indexed: 12/04/2022] Open
Abstract
Background A uterine arteriovenous malformation (AVM) is a rare cause of uterine bleeding. It may have varied presentations ranging from being completely asymptomatic; to features of congestive heart failure to vaginal bleeding which may at times life be threatening. Clinical findings in such cases are often un-reliable; requiring a high index of suspicion to make the diagnosis. Sonographic gray scale features are non-specific requiring confirmation with colour and spectral Doppler. Case Report We report a case of a 46-year-old lady who presented with heavy vaginal bleeding and ultrasound/colour Doppler evidence of uterine AVM managed by abdominal hysterectomy, describing the imaging features on ultrasound and Doppler. We also discuss in brief about this uncommon but serious condition which the radiologist/gynaecologist may encounter in thier practise. Conclusions Uterine AV Malformation is a rare but potentially life-threatening cause of menorrhagia which must be kept in the differential diagnosis of sudden and massive vaginal bleeding. Ultrasound remains the modality of choice in diagnosing the condition which requires a high index of clinical suspicion. Color and spectral Doppler ultrasound should be used to supplement the findings and to confirm the diagnosis.
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Affiliation(s)
- Rohit Bhoil
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, India
| | | | - Suhas Basavaiah
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, India
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Ferrazzani S, Iadarola R, Perrelli A, Botta A, Moresi S, Salvi S, Santucci S, Degennaro VA, De Carolis S. Use of an intrauterine inflated catheter balloon in massive post-partum hemorrhage: a series of 52 cases. J Obstet Gynaecol Res 2015; 40:1603-10. [PMID: 24888923 DOI: 10.1111/jog.12404] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/14/2014] [Indexed: 11/27/2022]
Abstract
AIM Massive post-partum hemorrhage (PPH) is an important cause of maternal death that occurs as a complication of delivery. We report a large case series to evaluate the efficacy of uterine balloon tamponade to treat PPH avoiding hysterectomy. MATERIAL AND METHODS This prospective study was conducted in two Italian hospitals (from December 2002 to July 2012). Fifty-two patients with PPH not responsive to uterotonics were treated by Rusch balloon. A follow-up was conducted among the study population to assess the subsequent fertility. RESULTS The most frequent cause of PPH was atony (59.6%), followed by placenta previa (21.2%), placenta accreta (9.6%), and placenta previa and accreta (9.6%). The balloon success rate to control hemorrhage was 75%. From the sample of 52 patients, 13 patients needed additional procedures. In three failure cases, other conservative techniques were used and the overall effectiveness of them was 80.7%. The follow-up group consisted of 31 women. Of these women, 24 women (77.4%) had no further pregnancies, but only one due to sterility. Four of seven patients with subsequent pregnancies made it to term without complications. CONCLUSIONS The Rusch balloon is effective in controlling non-traumatic PPH in 75% of cases. It is simple to use, readily available and cheap. If necessary, this technique does not exclude other procedures. We suggest that this balloon should be included routinely in the PPH protocol.
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Affiliation(s)
- Sergio Ferrazzani
- Department of Obstetrics and Gynaecology, Catholic University of Sacred Heart
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22
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A modified suture technique for hemorrhage during cesarean delivery complicated by complete placenta previa. Int J Gynaecol Obstet 2015; 129:26-9. [DOI: 10.1016/j.ijgo.2014.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/28/2014] [Accepted: 12/22/2014] [Indexed: 11/22/2022]
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Munro MG. Acute uterine bleeding unrelated to pregnancy: a Southern California Permanente Medical Group practice guideline. Perm J 2014; 17:43-56. [PMID: 24355890 DOI: 10.7812/tpp/13-018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute uterine bleeding unrelated to pregnancy has been defined as bleeding "sufficient in volume as to, in the opinion of the treating clinician, require urgent or emergent intervention." The Southern California Permanente Medical Group updated its guidelines for the management of this condition on the basis of the best available evidence, as identified in a systematic review of the available literature. Given the paucity of studies evaluating this condition, the guidelines, by necessity, include recommendations largely based on opinion or other sources such as case series that are, in general, categorized as low-quality evidence. Medical interventions with single or combined gonadal steroidal agents administered parenterally or orally show promise, but more high-quality studies are needed to better define the appropriate drugs, dose, and administrative scheduling. There is also some evidence that intrauterine tamponade may be useful in at least selected cases. Special attention must be paid to both diagnosing and treating inherited disorders of hemostasis, such as von Willebrand disease, that may otherwise be underdiagnosed in both adolescent and adult women.
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Affiliation(s)
- Malcolm G Munro
- Director of Gynecological Services for the Los Angeles Medical Center in California and a Professor in the Department of Obstetrics and Gynecology at the David Geffen School of Medicine at the University of California Los Angeles. E-mail:
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Dildy GA, Belfort MA, Adair CD, Destefano K, Robinson D, Lam G, Strong TH, Polon C, Massaro R, Bukkapatnam J, Van Hook JW, Kassis I, Sunderji S. Initial experience with a dual-balloon catheter for the management of postpartum hemorrhage. Am J Obstet Gynecol 2014; 210:136.e1-6. [PMID: 24055586 DOI: 10.1016/j.ajog.2013.09.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/03/2013] [Accepted: 09/10/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE When uterotonics fail to cause sustained uterine contractions and satisfactory control of hemorrhage after delivery, tamponade of the uterus can be effective in decreasing hemorrhage secondary to uterine atony. STUDY DESIGN These data are from a postmarketing surveillance study of a novel dual-balloon catheter tamponade device, the Belfort-Dildy Obstetrical Tamponade System (ebb). RESULTS A total of 57 women were enrolled: 55 women had the diagnosis of postpartum hemorrhage, and 51 women had uterine balloon placement within the uterine cavity. This study reports the outcomes in the 51 women who had uterine balloon placement within the uterine cavity for treatment of postpartum hemorrhage, as defined by the "Instructions for Use." We further assessed 4 subgroups: uterine atony only (n = 28 women), placentation abnormalities (n = 8 women), both uterine atony and placentation abnormalities (n = 9 women), and neither uterine atony nor placentation abnormalities (n = 6 women). The median (range) time interval between delivery and balloon placement was 2.2 hours (0.3-210 hours) for the entire cohort (n = 51 women) and 1.3 hours (0.5-7.0 hours) for the uterine atony only group (n = 28 women). Bleeding decreased in 22/51 of cases (43%), stopped in 28/51 of cases (55%), thus decreased or stopped in 50/51 of the cases (98%) after balloon placement. Nearly one-half (23/51) of all women required uterine balloon volumes of >500 mL to control bleeding. CONCLUSION We conclude that uterine/vaginal balloon tamponade is very useful in the management of postpartum hemorrhage because of uterine atony and abnormal placentation.
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Affiliation(s)
- Gary A Dildy
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - C David Adair
- Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, and Glenveigh Medical, LLC, Chattanooga, TN
| | | | | | - Garrett Lam
- Banner Good Samaritan Medical Center, Phoenix, AZ
| | | | | | | | | | - James W Van Hook
- University of Cincinnati, Greater Cincinnati OB/GYN, Cincinnati, OH
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Selby ST, Haughey M. Uterine arteriovenous malformation with sudden heavy vaginal hemmorhage. West J Emerg Med 2013; 14:411-4. [PMID: 24106528 PMCID: PMC3789894 DOI: 10.5811/westjem.2012.12.13025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/16/2012] [Accepted: 12/12/2012] [Indexed: 11/12/2022] Open
Abstract
Dysfunctional uterine bleeding (DUB) is a common presentation in the emergency department and has a wide differential. Most presentations of DUB are in hemodynamically stable patients and can be evaluated as an outpatient. Uterine arteriovenous malformation (AVM) is one presentation that can result in a life-threatening medical emergency with unexpected sudden and massive vaginal bleeding. We describe a case of a 24-year-old female with sudden heavy vaginal bleeding requiring a blood transfusion, ultrasound evidence of uterine AVM, and a treatment method of expectant management using an intrauterine device in an attempt to preserve fertility.
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Affiliation(s)
- Sarah T Selby
- Albert Einstein College of Medicine, Jacobi Medical Center, Department of Emergency Medicine, Bronx, New York
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Kumru P, Demirci O, Erdogdu E, Arısoy R, Ertekin AA, Tugrul S, Pekin O. The Bakri balloon for the management of postpartum hemorrhage in cases with placenta previa. Eur J Obstet Gynecol Reprod Biol 2013; 167:167-70. [PMID: 23298893 DOI: 10.1016/j.ejogrb.2012.11.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 11/05/2012] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the success rate of the Bakri balloon in the event of uncontrollable hemorrhage due to placenta previa. STUDY DESIGN We evaluated 25 patients who were treated with the Bakri balloon who had severe postpartum hemorrhage with placenta previa and failed medical treatment with uterotonic agents. RESULTS The Bakri balloon was inserted abdominally during cesarean section in 24 of 25 cases. In only one case was it inserted vaginally. The Bakri tamponade was effective in 22 cases (88%). There were three cases with failure: two patients needed an additional procedure (hypogastric artery ligation and B-Lynch suture) and one patient needed hysterectomy. CONCLUSIONS The Bakri balloon is the least invasive, rapid method in the management of bleeding due to placenta previa with minimal complications.
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Affiliation(s)
- Pınar Kumru
- Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
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Nishino K, Hayashi K, Chaya J, Kato N, Yamamuro O. Effective salvage of acute massive uterine bleeding using intrauterine balloon tamponade in a uterine adenomyosis patient on dienogest. J Obstet Gynaecol Res 2012; 39:738-41. [DOI: 10.1111/j.1447-0756.2012.02005.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kimihiro Nishino
- Department of Obstetrics and Gynecology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Kazumasa Hayashi
- Department of Obstetrics and Gynecology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Jyunya Chaya
- Department of Obstetrics and Gynecology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Noriko Kato
- Department of Obstetrics and Gynecology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Osamu Yamamuro
- Department of Obstetrics and Gynecology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
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Affiliation(s)
- P Tarneja
- Professor and Head, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411 040
| | - V K Tarneja
- Professor and Head, Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune - 411 040
| | - B S Duggal
- Classified Specialist (Obstetrics and Gynaecology). Military Hospital, Shillong - 793 007
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Jain V. Placement of a cervical cerclage in combination with an intrauterine balloon catheter to arrest postpartum hemorrhage. Am J Obstet Gynecol 2011; 205:e15-7. [PMID: 21392731 DOI: 10.1016/j.ajog.2011.01.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 01/24/2011] [Indexed: 11/30/2022]
Abstract
Placement of a cervical cerclage postpartum allows retention of a uterine tamponade balloon in women with a dilated cervix. This novel indication for a cervical cerclage may be a useful adjunct to intrauterine balloon catheter in management of postpartum uterine hemorrhage.
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Affiliation(s)
- Venu Jain
- Department of Obstetrics and Gynaecology, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada.
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Manaktala U, Dubey C, Takkar A, Gupta S. Condom Catheter Balloon in Management of Massive Nontraumatic Postpartum Hemorrhage During Cesarean Section. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Usha Manaktala
- Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Delhi, India
| | - Chandan Dubey
- Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Delhi, India
| | - Astha Takkar
- Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Delhi, India
| | - Sonali Gupta
- Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Delhi, India
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ALBAYRAK M, OZDEMIR I, KOC O, DEMIRARAN Y. Post-partum haemorrhage from the lower uterine segment secondary to placenta praevia/accreta: Successful conservative management with Foley balloon tamponade. Aust N Z J Obstet Gynaecol 2011; 51:377-80. [DOI: 10.1111/j.1479-828x.2011.01309.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Majumdar A, Saleh S, Davis M, Hassan I, Thompson PJ. Use of balloon catheter tamponade for massive postpartum haemorrhage. J OBSTET GYNAECOL 2010; 30:586-93. [DOI: 10.3109/01443615.2010.494202] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ghourab S, Al-Nuaim L, Al-Jabari A, Al-Meshari A, Mustafa MS, Abotalib Z, Al-Salman M. Abdomino-pelvic packing to control severe haemorrhage following caesarean hysterectomy. J OBSTET GYNAECOL 2009; 19:155-8. [PMID: 15512258 DOI: 10.1080/01443619965480] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Surgically uncontrollable peri-operative obstetric haemorrhage associated with coagulopathy, developed in five women who were managed by emergency caesarean hysterectomy. All women had a morbidly adherent anterior placenta praevia and a previous lower segment caesarean section scar. Conventional medical and surgical therapy to control bleeding from pelvic and abdominal raw surfaces were unsuccessful. Abdomino-pelvic packing was performed with 10-12 dry laparotomy pads applied firmly over bleeding sites. The abdomen was closed after observation of the cessation of bleeding for 5-10 minutes. Following correction of coagulation and haemodynamic disorders relaparotomy for pack removal was performed 34-48 hours later. One patient developed small bowel obstruction on the 5th post-operative day, however, there was no long term gynaecological morbidity in any of the cases. Abdomino-pelvic packing achieved complete haemostasis in all of the five women which we believe may have been impossible using alternative measures.
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Affiliation(s)
- S Ghourab
- Department of Obstetrics and Gynaecology, King Khalid University Hospital, Riyadh, Saudi Arabia
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Olamijulo JA, Doufekas K. Intrauterine balloon tamponade for uncontrollable bleeding during first trimester surgical termination of pregnancy. J OBSTET GYNAECOL 2009; 27:440-1. [PMID: 17654213 DOI: 10.1080/01443610701359696] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J A Olamijulo
- Department of Obstetrics and Gynaecology, Pilgrim Hospital, Boston, UK.
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Roman H, Loisel C, Puscasiu L, Sentilhes L, Marpeau L. Hiérarchisation des stratégies thérapeutiques pour ménométrorragies avec ou sans désir de grossesse. ACTA ACUST UNITED AC 2008; 37 Suppl 8:S405-17. [DOI: 10.1016/s0368-2315(08)74781-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic Review of Conservative Management of Postpartum Hemorrhage: What to Do When Medical Treatment Fails. Obstet Gynecol Surv 2007; 62:540-7. [PMID: 17634155 DOI: 10.1097/01.ogx.0000271137.81361.93] [Citation(s) in RCA: 250] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We performed a systematic review to identify all studies evaluating the success rates of treatment of major postpartum hemorrhage by uterine balloon tamponade, uterine compression sutures, pelvic devascularization, and arterial embolization. We included studies reporting on at least 5 cases. All searches were performed independently by 2 researchers and updated in June 2006. Failure of management was defined as the need to proceed to subsequent or repeat surgical or radiological therapy or hysterectomy, or death. As the search identified no randomized controlled trials, we proceeded to search for observational studies. This identified 396 publications, and after exclusions, 46 studies were included in the systematic review. The cumulative outcomes showed success rates of 90.7% (95% confidence interval [CI], 85.7%-94.0%) for arterial embolization, 84.0% (95% CI, 77.5%-88.8%) for balloon tamponade, 91.7% (95% CI, 84.9%-95.5%) for uterine compression sutures, and 84.6% (81.2%-87.5%) for iliac artery ligation or uterine devascularization (P = 0.06). At present there is no evidence to suggest that any one method is better for the management of severe postpartum hemorrhage. Randomized controlled trials of the various treatment options may be difficult to perform in practice. As balloon tamponade is the least invasive and most rapid approach, it would be logical to use this as the first step in the management.
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Affiliation(s)
- Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, St George's, University of London, London, United Kingdom
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Abstract
Diagnostic and operative hysteroscopic procedures are performed to evaluate women with abnormal uterine bleeding structural uterine anomalies. Diagnostic and minimally invasive hysteroscopic surgical procedures in the hands of well-trained, experienced hysteroscopists offer little chance of serious complications. More extensive procedures offer greater risks, with fluid overload being the most common. The well-prepared and experienced hysteroscopic surgeon should have the ability, equipment, ancillary personnel, and facilities to prevent and to treat this problem, as well as the knowledge necessary to handle mechanical accidents, anesthetic complications, and post-procedure infections. The greatest risk in this procedure is, as always, an inadequately trained or ill-prepared operator.
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Kafali H, Demir N, Soylemez F, Yurtseven S. Hemostatic cervical suturing technique for management of uncontrollable postpartum haemorrhage originating from the cervical canal. Eur J Obstet Gynecol Reprod Biol 2003; 110:35-8. [PMID: 12932868 DOI: 10.1016/s0301-2115(03)00104-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of a novel cervical suturing technique for management of uncontrollable postpartum haemorrhage originating from the cervical canal. STUDY DESIGN Cervical suturing was performed on three women to control intractable postpartum haemorrhage originating from the cervical canal and not responding to classic management. Haemostatic cervical suturing by using no. 1 chromic catgut is a new surgical technique which approximates anterior and posterior cervical lips. It controls cervical haemorrhage by attachment and compression of the haemorrhage site of the cervical lips and lower uterine segment. RESULTS The procedure was effective in all cases and hysterectomy was not needed in any case. No complication occurred and the survival rate was 100%. The procedure required no special expertise or extraordinary equipment. CONCLUSION Cervical suturing technique for management of postpartum haemorrhage originating from the cervical canal is an easy, safe and highly effective conservative surgical technique that may be alternative to hysterectomy.
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Affiliation(s)
- Hasan Kafali
- Department of Obstetrics & Gynecology, Harran University, Medical School, 63100, Sanliurfa, Turkey.
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Fahy U, Sved A, Burke G. Successful balloon tamponade of post cesarean hysterectomy pelvic bleeding: a case report. Acta Obstet Gynecol Scand 2003; 82:97-8. [PMID: 12580850 DOI: 10.1034/j.1600-0412.2003.820119.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Una Fahy
- Limerick Regional Maternity Hospital, Limerick, Ireland.
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Hysteroscopic Complications. J Low Genit Tract Dis 2002. [DOI: 10.1097/00128360-200201000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Galka E, Goldfarb HA. Disseminated intravascular coagulation as a complication of intrauterine balloon tamponade for posthysteroscopic acute uterine bleeding. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2000; 7:573-6. [PMID: 11044516 DOI: 10.1016/s1074-3804(05)60378-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although there is anecdotal evidence of balloon tamponade for posthysteroscopic acute uterine bleeding, a literature review disclosed no articles describing complications of the technique. In our patient, balloon tamponade for acute posthysteroscopic bleeding resulted in disseminated intravascular coagulation. In a second woman the procedure was successful.
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Affiliation(s)
- E Galka
- 29 The Crescent, Montclair, NJ 07042, USA
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Cooper JM, Brady RM. Intraoperative and early postoperative complications of operative hysteroscopy. Obstet Gynecol Clin North Am 2000; 27:347-66. [PMID: 10857125 DOI: 10.1016/s0889-8545(00)80026-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
With preoperative evaluation, meticulous technique, and vigilance for impending problems, intraoperative and early postoperative complications of operative hysteroscopy are largely preventable. Fluid overload is the most common serious complication. The hysteroscopist must understand the significant differences between hypotonic, electrolyte-free distention media and isotonic, electrolyte-containing media and their respective sequelae. As new operative tools become available, hypotonic and electrolyte-free distention media may become obsolete. The physiology and management of air embolism, the most grave intraoperative complication, are essential to the knowledge base of any active hysteroscopist. Mechanical accidents, anesthetic complications, laser and electrical injury, and infections can be reduced by knowledge and preparation. Technologic advances, ongoing research, and postgraduate training in hysteroscopic technique continue to expand the safe and beneficial applications of hysteroscopy into the next century.
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Affiliation(s)
- J M Cooper
- Department of Obstetrics and Gynecology, University of Arizona, School of Medicine, Phoenix Baptist Hospital, USA
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Chan C, Razvi K, Tham KF, Arulkumaran S. The use of a Sengstaken-Blakemore tube to control post-partum hemorrhage. Int J Gynaecol Obstet 1997; 58:251-2. [PMID: 9252266 DOI: 10.1016/s0020-7292(97)00090-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C Chan
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
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Loffer FD. Complications of hysteroscopy-their cause, prevention, and correction. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1995; 3:11-26. [PMID: 9050612 DOI: 10.1016/s1074-3804(05)80132-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Complications of hysteroscopy occur more frequently in operative than in diagnostic cases. Problems related to uterine distention are common, usually preventable, and potentially extremely serious. Perforation of the uterus may occur during hysteroscopy but do not always cause significant problems. In procedures of high risk for perforation the use of mechanical energy is safer than either laser or electrical energy. Laparoscopy and ultrasonography have some limited use in facilitating operative hysteroscopic procedures. Most complications occur during the hysteroscopic surgical procedure. However, some problems may not be apparent until the post operative period.
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Affiliation(s)
- F D Loffer
- Department of Gynecologic Endoscopy, Maricopa Medical Center, 3410 North 4th Avenue, Phoenix, AZ 85013, USA
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Katesmark M, Brown R, Raju KS. Successful use of a Sengstaken-Blakemore tube to control massive postpartum haemorrhage. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1994; 101:259-60. [PMID: 8193105 DOI: 10.1111/j.1471-0528.1994.tb13124.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- M Katesmark
- Division of Obstetrics and Gynaecology, St. Thomas's Hospital, London, UK
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