1
|
Shan D, Han J, Li T, Hu Y. Cesarean section "en caul" in preterm twin pregnancy: experience of a single center. Arch Gynecol Obstet 2024:10.1007/s00404-024-07472-8. [PMID: 38575799 DOI: 10.1007/s00404-024-07472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE The "en caul" cesarean section (CS) is a method to keep the amnion intact during CS. This amnion protection effect may have benefits in preterm twin pregnancy. This study aimed to explore the benefits and risks of this method in preterm twin pregnancy. METHODS This study is a retrospective analysis of preterm twin pregnancies underwent CS in West China Second University Hospital of Sichuan University from January 2011 to December 2022. Data on maternal and fetal outcomes were collected. Univariable analyses and multivariate logistic regression analyses were applied. The level of significance was set at p < 0.05. RESULTS A total of 182 patients were included (90 in the "en caul" group, 92 in the conventional group). "en caul" CS was associated with lower incidence for respiratory distress (aOR 0.47, 95% CI 0.25-0.88, for the first fetus; aOR 0.42, 95% CI 0.21-0.82, for the second fetus). This method was proved to have beneficial effects in improving the Apgar scores at 1st minute and reducing the mechanical ventilation rate in the second neonates (aOR 0.41, 95% CI 0.19-0.88). CONCLUSION "En caul" CS is an easy and safe technique to perform during CS for preterm twin pregnancy. The efficacy and safety of this method could be tested by future studies with larger sample size.
Collapse
Affiliation(s)
- Dan Shan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, South Renmin Road, Section 3, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Jinbiao Han
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, South Renmin Road, Section 3, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Tao Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, South Renmin Road, Section 3, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China.
| | - Yayi Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, South Renmin Road, Section 3, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
2
|
Tachi S, Yoneda N, Yoneda S, Saito S. Successful treatment of total placenta previa by multidisciplinary therapy in a Jehovah's Witness patient who refused blood transfusions. BMJ Case Rep 2018; 2018:bcr-2018-226486. [PMID: 30413456 DOI: 10.1136/bcr-2018-226486] [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: 11/03/2022] Open
Abstract
A 35-year-old Jehovah's Witness patient with total placenta previa was referred to our hospital at 30 weeks of gestation. She refused autologous and allogeneic blood transfusions, but agreed to receive acute normovolaemic haemodilution, intraoperative blood salvage and biological products. At 35 weeks, she underwent emergent caesarean delivery because of labour pains. Multidisciplinary therapy, including the insertion of balloon catheters into the bilateral common iliac arteries, acute normovolaemic haemodilution and intraoperative blood salvage, avoided hysterectomy; however, blood loss included amniotic fluid which was estimated to be 1910 mL. These treatments may be effective for total placenta previa in blood-refusal patients.
Collapse
Affiliation(s)
- Sayaka Tachi
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Noriko Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Satoshi Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| |
Collapse
|
3
|
Elagamy A, Abdelaziz A, Ellaithy M. The use of cell salvage in women undergoing cesarean hysterectomy for abnormal placentation. Int J Obstet Anesth 2013; 22:289-93. [DOI: 10.1016/j.ijoa.2013.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 04/05/2013] [Accepted: 05/20/2013] [Indexed: 11/25/2022]
|
4
|
Autologous blood in obstetrics: where are we going now? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 10:125-47. [PMID: 22044959 DOI: 10.2450/2011.0010-11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 06/06/2011] [Indexed: 11/21/2022]
|
5
|
Liumbruno GM, Meschini A, Liumbruno C, Rafanelli D. The introduction of intra-operative cell salvage in obstetric clinical practice: a review of the available evidence. Eur J Obstet Gynecol Reprod Biol 2011; 159:19-25. [PMID: 21742428 DOI: 10.1016/j.ejogrb.2011.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/13/2011] [Accepted: 06/09/2011] [Indexed: 10/18/2022]
Abstract
Intra-operative blood salvage is common practice in many surgical specialties but its safety is questioned with concerns about the risks of contamination of recovered blood with amniotic fluid and of maternal-foetal alloimmunization. However, the role of cell salvage as a blood-saving measure in this clinical setting is progressively acquiring relevance thanks to the growing body of evidence regarding its quality and safety. Modern cell savers remove most particulate contaminants and leukodepletion filtering of salvaged blood prior to transfusion adds further safety to this technique. Amniotic fluid embolism is no longer regarded as an embolic disease and the contamination of the salvaged blood by foetal Rh-mismatched red blood cells can be dealt with using anti-D immunoglobulin; ABO incompatibility tends to be a minor problem since ABO antigens are not fully developed at birth. Maternal alloimmunization can be caused also by other foetal red cell antigens, but it should also be noted that the risk of alloimmunization of the mother from allogeneic transfusion may be even greater. Therefore the use of cell savers in obstetric clinical practice should be considered in patients at high risk for haemorrhage or in cases where allogeneic blood transfusion is difficult or impossible.
Collapse
Affiliation(s)
- Giancarlo Maria Liumbruno
- UOC Immunoematologia e Medicina Trasfusionale, San Giovanni Calibita Fatebenefratelli Hospital, AFAR, Rome, Italy.
| | | | | | | |
Collapse
|
6
|
Liumbruno GM, Liumbruno C, Rafanelli D. Intraoperative cell salvage in obstetrics: is it a real therapeutic option? Transfusion 2011; 51:2244-56. [DOI: 10.1111/j.1537-2995.2011.03116.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Geoghegan J, Daniels JP, Moore PAS, Thompson PJ, Khan KS, Gülmezoglu AM. Cell salvage at caesarean section: the need for an evidence-based approach. BJOG 2009; 116:743-7. [DOI: 10.1111/j.1471-0528.2009.02129.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|