1
|
Yu SCH, Cheng YKY, Tse WT, Sahota DS, Chung MY, Wong SSM, Chan OK, Leung TY. Perioperative prophylactic internal iliac artery balloon occlusion in the prevention of postpartum hemorrhage in placenta previa: a randomized controlled trial. Am J Obstet Gynecol 2020; 223:117.e1-117.e13. [PMID: 31978436 DOI: 10.1016/j.ajog.2020.01.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Placenta previa remains one of the major causes of massive postpartum hemorrhage and maternal mortality worldwide. OBJECTIVE To determine whether internal iliac artery balloon occlusion during cesarean delivery for placenta previa could reduce postpartum hemorrhage and other maternal complications. STUDY DESIGN This was a prospective randomized controlled trial conducted at a tertiary university obstetric unit in Hong Kong. Pregnant women who were diagnosed to have placenta previa at 34 weeks (defined as lower placenta edge within 2 cm from the internal os) and required cesarean delivery were invited to participate. Eligible pregnant women were randomized into internal iliac artery balloon occlusion (Occlusion) group or standard management (Control) group. Those randomized to the Occlusion group had internal iliac artery balloon catheter placement performed before cesarean delivery and then balloon inflation after delivery of the baby. The primary outcome was the reduction of postpartum hemorrhage in those with internal iliac artery balloon occlusion. Secondary outcome measures included hemoglobin drop after delivery; amount of blood product transfusion; incidence of hysterectomy; maternal complications including renal failure, ischemic liver, disseminated intravascular coagulation, and adult respiratory distress syndrome; length of stay in hospital; admission to intensive care unit; and maternal death. RESULTS Between May 2016 and September 2018, 40 women were randomized (20 in each group). Demographic and obstetric characteristics were similar between the 2 groups. In the Occlusion group, 3 women did not receive the scheduled procedure, as it was preceded by antepartum hemorrhage that required emergency cesarean delivery, and 1 woman had repeated scan at 36 weeks showing the placental edge was slightly more than 2 cm from the internal os. Intention-to-treat analysis found no significant differences between the Occlusion and the Control groups regarding to the median intraoperative blood loss (1451 [1024-2388] mL vs 1454 [888-2300] mL; P = .945), the median length of surgery (49 [30-62] min vs 37 [30-51] min; P = .204), or the need for blood transfusion during operation (57.9% vs 50.0%; P = .621). None of the patients had rebleeding after operation, complication related to internal iliac artery procedure, or any other maternal complications. Reanalyzing the data using on-treatment approach showed the same results. CONCLUSION The use of prophylactic internal iliac artery balloon occlusion in placenta previa patients undergoing cesarean delivery did not reduce postpartum hemorrhage or have any effect on maternal or neonatal morbidity.
Collapse
|
2
|
Alalfy M, Hussein E, Saber W, Elsharkawy M, Salama S, Lasheen Y, Elshafey D, Taher A, Farouk D, Eltaieb E, Elsirgany S, Hussein M, Fikry M, Hassan H, Sadek J, Alaa D, Torad H, Abdella R, Ali S, Yehia A, Lotfy R, Hanafy A, Hassan A. Alalfy modified cervical inversion technique as a tamponade in controlling PPH in placenta previa, a multicentric double blind randomized controlled trial. J Matern Fetal Neonatal Med 2019; 34:3162-3168. [PMID: 31630600 DOI: 10.1080/14767058.2019.1678140] [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: 10/25/2022]
Abstract
INTRODUCTION Postpartum hemorrhage that occurs frequently with placenta previa is one of the causes of maternal mortality in 14% in developing countries. OBJECTIVE To assess efficacy of cervical inversion as a tamponade in controlling bed of placenta in cases of placenta previa. PATIENTS AND METHOD A prospective randomized controlled study was conducted among a total of 240 pregnant women with placenta previa (120 subjected to Alalfy modified cervical inversion technique plus hemostatic sutures and 120 was not subjected cervical inversion and only was subjected to hemostatic sutures in Obstetrics and Gynecology Department at Suez Canal University hospital, Helwan University and Algezeerah hospital for a planned cesarean section). RESULTS The mean intraoperative blood loss, the intraoperative time, and the postoperative hemoglobin show a statistically significant difference between cases with placenta previa who were exposed to cervical inversion in comparison to cases that had no cervical inversion with a p-value <.001. CONCLUSION Modified cervical inversion (Alalfy technique) as a tamponade when added to hemostatic sutures to the placental bed is an easy, rapid, and efficient procedure that can decrease the amount of blood loss, time needed to stop bleeding per bed, total operative time, also it can decrease the need for blood transfusion.
Collapse
Affiliation(s)
- Mahmoud Alalfy
- Reproductive Health and Family Planning Department, National Research Centre, Giza, Egypt.,Department of Obstetrics and Gynecology, Algezeerah Hospital, Giza, Egypt
| | - Elham Hussein
- Obstetrics and Gynecology Department, Suez Canal University, Al Ismailia, Egypt
| | - Waled Saber
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Elsharkawy
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sameh Salama
- Reproductive Health and Family Planning Department, National Research Centre, Giza, Egypt.,Department of Obstetrics and Gynecology, Algezeerah Hospital, Giza, Egypt
| | - Yossra Lasheen
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Elshafey
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Taher
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Farouk
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - E Eltaieb
- Obstetrics and Gynecology Department, Ainshams Faculty of Medicine, Cairo, Egypt
| | - Sherif Elsirgany
- Reproductive Health and Family Planning Department, National Research Centre, Giza, Egypt.,Department of Obstetrics and Gynecology, Algezeerah Hospital, Giza, Egypt
| | - Mohamed Hussein
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Fikry
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hatem Hassan
- Reproductive Health and Family Planning Department, National Research Centre, Giza, Egypt.,Department of Obstetrics and Gynecology, Algezeerah Hospital, Giza, Egypt
| | - Jehan Sadek
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Alaa
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hesham Torad
- Urology Department, Kasralainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rana Abdella
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sief Ali
- Obstetrics and Gynecology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Amera Yehia
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Lotfy
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amal Hanafy
- Obstetrics and Gynecology Department, Kasr alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hassan
- Obstetrics and Gynecology Department, Helwan Faculty of Medicine, Helwan University, Helwan, Egypt
| |
Collapse
|
3
|
Greenberg JA, Robinson JN, Carabuena JM, Farber MK, Carusi DA. Use of a Fibrin Sealant Patch at Cesarean for Conservative Management of Morbidly Adherent Placenta. AJP Rep 2018; 8:e325-e327. [PMID: 30443434 PMCID: PMC6235679 DOI: 10.1055/s-0038-1675848] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/06/2018] [Indexed: 11/04/2022] Open
Abstract
Background Morbidly adherent placenta represents a surgical challenge and source of maternal morbidity and mortality. We report the use of a fibrin sealant patch to address hemorrhage associated with a morbidly adherent placenta during cesarean delivery. Case A patient underwent repeat cesarean delivery with complete anterior placenta previa and anticipated morbidly adherent placenta. Bleeding persisted following delivery and removal of the placenta, despite uterine artery embolization. A fibrin sealant patch was applied as an adjuvant intervention to the placental bed and hemostasis was achieved without resorting to a hysterectomy. Conclusion Postpartum hemorrhage is an ongoing leading source of maternal morbidity and mortality. A case is presented in which a fibrin sealant patch provided control of focal placental bed bleeding, allowing removal of a focal morbidly adherent placenta and avoidance of hysterectomy.
Collapse
Affiliation(s)
- James A Greenberg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Julian N Robinson
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jean M Carabuena
- Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michaela K Farber
- Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniela A Carusi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
4
|
Hussein AM, Dakhly DMR, Raslan AN, Kamel A, Abdel Hafeez A, Moussa M, Hosny AS, Momtaz M. The role of prophylactic internal iliac artery ligation in abnormally invasive placenta undergoing caesarean hysterectomy: a randomized control trial. J Matern Fetal Neonatal Med 2018; 32:3386-3392. [PMID: 29635951 DOI: 10.1080/14767058.2018.1463986] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To identify the role of bilateral internal iliac artery (IIA) ligation on reducing blood loss in abnormally invasive placenta (AIP) undergoing caesarean hysterectomy. Methods: In this parallel-randomized control trial, 57 pregnant females with ultrasound features suggestive of AIP were enrolled. They were randomized into two groups; IIA group (n = 29 cases) performed bilateral IIA ligation followed by caesarean hysterectomies, while Control group (n = 28 cases) underwent caesarean hysterectomy only. The main outcome was the difference in the estimated intraoperative blood loss between the two groups. Results: There was no significant difference between the two groups regarding the intraoperative estimated blood loss (1632 ± 804 versus 1698 ± 1251, p value .83). The operative procedure duration (minutes) (223 ± 66 versus 171 ± 41.4, p value .001) varied significantly between the two groups. Conclusions: Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.
Collapse
Affiliation(s)
- Ahmed M Hussein
- a Department of Obstetrics and Gynaecology , Cairo University , Cairo , Egypt
| | | | - Ayman N Raslan
- a Department of Obstetrics and Gynaecology , Cairo University , Cairo , Egypt
| | - Ahmed Kamel
- a Department of Obstetrics and Gynaecology , Cairo University , Cairo , Egypt
| | - Ali Abdel Hafeez
- a Department of Obstetrics and Gynaecology , Cairo University , Cairo , Egypt
| | - Manal Moussa
- a Department of Obstetrics and Gynaecology , Cairo University , Cairo , Egypt
| | | | - Mohamed Momtaz
- a Department of Obstetrics and Gynaecology , Cairo University , Cairo , Egypt
| |
Collapse
|
5
|
Schjoldager BTBG, Mikkelsen E, Lykke MR, Præst J, Hvas AM, Heslet L, Secher NJ, Salvig JD, Uldbjerg N. Topical application of recombinant activated factor VII during cesarean delivery for placenta previa. Am J Obstet Gynecol 2017; 216:608.e1-608.e5. [PMID: 28219621 DOI: 10.1016/j.ajog.2017.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/27/2017] [Accepted: 02/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND During cesarean delivery in patients with placenta previa, hemorrhaging after removal of the placenta is often challenging. In this condition, the extraordinarily high concentration of tissue factor at the placenta site may constitute a principle of treatment as it activates coagulation very effectively. The presumption, however, is that tissue factor is bound to activated factor VII. OBJECTIVE We hypothesized that topical application of recombinant activated factor VII at the placenta site reduces bleeding without affecting intravascular coagulation. STUDY DESIGN We included 5 cases with planned cesarean delivery for placenta previa. After removal of the placenta, the surgeon applied a swab soaked in recombinant activated factor VII containing saline (1 mg in 246 mL) to the placenta site for 2 minutes; this treatment was repeated once if the bleeding did not decrease sufficiently. We documented the treatment on video recordings and measured blood loss. Furthermore, we determined hemoglobin concentration, platelet count, international normalized ratio, activated partial thrombin time, fibrinogen (functional), factor VII:clot, and thrombin generation in peripheral blood prior to and 15 minutes after removal of the placenta. We also tested these blood coagulation variables in 5 women with cesarean delivery planned for other reasons. Mann-Whitney test was used for unpaired data. RESULTS In all 5 cases, the uterotomy was closed under practically dry conditions and the median blood loss was 490 (range 300-800) mL. There were no adverse effects of recombinant activated factor VII and we did not measure factor VII to enter the circulation. Neither did we observe changes in thrombin generation, fibrinogen, activated partial thrombin time, international normalized ratio, and platelet count in the peripheral circulation (all P values >.20). CONCLUSION This study indicates that in patients with placenta previa, topical recombinant activated factor VII may diminish bleeding from the placenta site without initiation of systemic coagulation.
Collapse
Affiliation(s)
| | - Emmeli Mikkelsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Malene R Lykke
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Præst
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels J Secher
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jannie D Salvig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
6
|
Macharey G, Ulander VM, Kostev K, Väisänen-Tommiska M, Ziller V. Emergency peripartum hysterectomy and risk factors by mode of delivery and obstetric history: a 10-year review from Helsinki University Central Hospital. J Perinat Med 2015; 43:721-8. [PMID: 24756039 DOI: 10.1515/jpm-2013-0348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/17/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to estimate the occurrence of emergency peripartum hysterectomy (EPH) and to quantify its risk factors in connection with the mode of delivery and the obstetric history of patients at the Helsinki University Central Hospital, Finland. METHODS In a retrospective, matched case-control study we identified 124 cases of EPH from 2000 to 2010 at our hospital. These were matched with 248 control patients. RESULTS The incidence rate of EPH was 9.9/10,000. Patients whose current delivery was vaginal, and had a cesarean section (CS) in their history had a six-fold risk for EPH. Women who underwent their first CS had a nine times higher risk, while patients who currently underwent CS and had a history of previous CS, had a 22 times higher risk. Those who experienced prostaglandin-E1 induction had a five-fold risk. Maternal age >35 years, previous curettage, and twin pregnancy were identified as significant risk factors. In 41 cases, interventions to reduce bleeding were performed. CONCLUSION Obstetric emergency training and guidelines for massive hemorrhage should be established in any delivery department. Moreover, all possible precautions should be taken to avoid the first CS if it is obstetrically unnecessary. Induction with prostaglandin-E1, maternal age >35 years, previous curettage, twin pregnancies, and early gestation were identified as risk factors for EPH.
Collapse
|
7
|
Miller DT, Roque DM, Santin AD. Use of Monsel solution to treat obstetrical hemorrhage: a review and comparison to other topical hemostatic agents. Am J Obstet Gynecol 2015; 212:725-35. [PMID: 25577672 PMCID: PMC4457701 DOI: 10.1016/j.ajog.2014.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
Peripartum hemorrhage accounts for 8% of maternal deaths in the United States, and nearly 27% worldwide. A growing need exists for tactics to spare morbidity given a rise of abnormal placentation that contributes to excessive blood loss at the time of delivery. Approaches such as compression sutures, balloon tamponade, and pelvic artery embolization are not without side effects and potential implications for future fertility. The use of topical hemostatic agents has become widespread in gynecologic and obstetric surgery despite a paucity of distinct studies in the field, and may allow providers to increasingly avoid cesarean hysterectomy. A variety of topical hemostatic agents exist along a wide cost continuum, each characterized by specific efficacy, advantages, drawbacks, and often gaps in long-term data to support safety and impact on future fertility. Herein, we comprehensively review these agents and illustrate a nontraditional use of Monsel solution applied directly to the placental bed in a case of focal placenta accreta. This ultimately contributed to successful uterine preservation with no known adverse sequelae. Monsel solution may have a role in establishing hemostasis in the setting of abnormal placentation, and may be a particularly attractive alternative in resource-poor nations.
Collapse
Affiliation(s)
- Devin T Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Dana M Roque
- University of Maryland School of Medicine, Baltimore, MD
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
| |
Collapse
|
8
|
Díaz-Güemes I, Enciso S, Pérez-Medina T, Casado JG, Sánchez-Margallo FM. Hemostatic sponge effect on adhesion prevention in a porcine model. J Surg Res 2014; 194:312-8. [PMID: 25454970 DOI: 10.1016/j.jss.2014.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/26/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND In this work, we aimed to assess the preventive effect of an absorbable hemostatic collagen sponge (HCS) on the reduction of postsurgical gynecological adhesions in a porcine model. MATERIALS AND METHODS Forty female pigs were subjected to a right uterine horn myotomy and left uterine horn deserosation. They were randomly divided into two groups, HCS application and control, which were rearranged into laparotomy and laparoscopy groups. Resulting adhesions were macroscopically and microscopically semiquantitatively analyzed after a 5 mo follow-up. RESULTS The incidence of adhesion-free animals did not significantly differ between groups, although it increased when the HCS was placed in both laparotomy (from 10%-12.5%) and laparoscopy groups (from 20%-50%). On the contrary, a significant reduction was observed in adhesion severity when the HCS was applied in the laparotomy groups (P < 0.01). Regarding microscopic study, hemostatic sponge application significantly reduced the inflammation score in the laparoscopic approach (P < 0.01). Fibrosis, unlike inflammation, differs between both approaches. In the laparoscopic group, fibrosis was reduced with application of the HCS, whereas in the laparotomy group greater fibrosis was observed within the HCS group. CONCLUSIONS HCS has shown to be safe for gynecological use. Although number and extent of adhesions did not decrease with HCS, inflammation and adhesions' severity were reduced in the laparoscopic and laparotomy approaches, respectively.
Collapse
Affiliation(s)
| | - Silvia Enciso
- Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain.
| | - Tirso Pérez-Medina
- Department of Obstetrics and Gynecology, Puerta de Hierro University Hospital, Autónoma University of Madrid, Madrid, Spain
| | - Javier G Casado
- Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain
| | | |
Collapse
|
9
|
Cervical inversion as a novel technique for postpartum hemorrhage management during cesarean delivery for placenta previa accreta/increta. Int J Gynaecol Obstet 2014; 128:122-5. [DOI: 10.1016/j.ijgo.2014.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 08/20/2014] [Accepted: 10/20/2014] [Indexed: 12/25/2022]
|
10
|
|
11
|
Sahhaf F, Abbasalizadeh S, Ghojazadeh M, Velayati A, Khandanloo R, Saleh P, Piri R, Naghavi-Behzad M. Comparison effect of intravenous tranexamic acid and misoprostol for postpartum haemorrhage. Niger Med J 2014; 55:348-53. [PMID: 25114373 PMCID: PMC4124551 DOI: 10.4103/0300-1652.137228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Postpartum haemorrhage (PPH) is the third-most common cause of maternal death in the United States and it is still the first prevalent cause of maternal death in developing countries. Active prevention of haemorrhage with an uterotonic or other new drugs leads to a decrease in postpartum vaginal haemorrhage. The aim of this study was to compare anti-haemorrhagic effect of Tranexamic acid (TXA) and Misoprostol for PPH. Patients and Methods: In a double-blinded randomised control clinical trial, 200 women were included after Caesarean or natural vaginal delivery with abnormal PPH. They were divided into two equal intervention and control groups. Effect of intravenous TXA and Misoprostol for postpartum haemorrhage was examined. Results: The mean age of patients was 26.7 ± 6.5 years which ranged from 14 to 43 years. The sonographic gestational age in the group treated with TXA was 37.7 ± 3.4 weeks and it was 37.4 ± 3.3 weeks for the other group (P = 0.44). The haemorrhage in the TXA and Misoprostol groups was 1.2 ± 0.33 litres and 1.18 ± 0.47 litres, respectively (P = 0.79). The haemoglobin levels after 6-12 hours of labour, in TXA group was more than that of the Misoprostol group, but this difference was not statistically significant (P = 0.22 and P = 0.21, respectively). Conclusion: Regarding to the superior results in Misoprostol group in one hand and lack of significant differences between two groups in haemorrhage during labour, post-partum haemoglobin level and discharge haemoglobin level, we can state that Misoprostol has no specific preferences to TXA, but more studies with greater population are needed.
Collapse
Affiliation(s)
- Farnaz Sahhaf
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shamsi Abbasalizadeh
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefeh Velayati
- Department of Midwifery, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Roya Khandanloo
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parviz Saleh
- Infectious and Tropical Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Piri
- Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Naghavi-Behzad
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
12
|
Raiffort C, Benabdallah F, Paillasseur JL, Gangner Y, Leutenegger E, Sockeel P. Patient eligibility criteria for a surgical treatment that enhances tissue sealing by use of a medicated sponge: observational study ELITE. SPRINGERPLUS 2013; 2:613. [PMID: 24307983 PMCID: PMC3847034 DOI: 10.1186/2193-1801-2-613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 11/08/2013] [Indexed: 11/23/2022]
Abstract
Rationale The application of a haemostatic agent in general surgery, in addition to its effect on bleeding, also provides tissue sealing and adhesion. A sponge drug is used with some actions of resection and wide dissection, without knowledge of the eligibility of patients. In this study, we sought to identify clusters of patients for which the medicated sponge enhances tissue sealing. Methods Observational study (ELITE), from a panel of selected surgeons from hospitals in France in several surgical areas: abdominal, gynaecology, urology and thoracic. The survey identified the criteria for using the sponge TachoSil® in their surgical practices involving n = 683 patients. A multiple correspondence analysis (MCA) followed by an ascending hierarchical classification (AHC) was used in order to identify the eligibility criteria for the application of the sponge for tissue sealing in addition to hemostasis. Results The most relevant classification was based on 9 groups of patients for which the sponge was used. 6 of them are mainly linked with the kind of lesion, 2 with the site of application and the latest one with the type of operation. Conclusions The ELITE study revealed that the TachoSil® sponge was used mainly during surgery, requiring a reinforcement of the resection tissue sealing. The expected objective was successfully reached in 97% of the cases. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-2-613) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Cyril Raiffort
- General and Gynaecologic Surgery, University Hospital of Lariboisière, 2 rue Amboise Paré, 75475 Paris, Cedex 10, France
| | | | | | | | | | | |
Collapse
|
13
|
Antony KM, Dildy GA. Postpartum hemorrhage: the role of the Maternal-Fetal Medicine specialist in enhancing quality and patient safety. Semin Perinatol 2013; 37:246-56. [PMID: 23916023 DOI: 10.1053/j.semperi.2013.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Postpartum hemorrhage in excess of 1000 mL affects 2.9-4.3% of deliveries in North America and the prevalence is increasing (Calvert et al., 2012(1); Callaghan et al., 2010(2)). Given the unpredictable nature of most postpartum hemorrhages, all obstetric providers must understand the initial steps in the assessment and management of this emergency. In this monograph we will review the potential role of the Maternal-Fetal Medicine (MFM) specialist in managing this acute obstetric emergency. MFMs are uniquely positioned to develop hospital protocols, advocate for investment in resources to optimize outcomes, and utilize novel educational models, such as simulation, to educate other providers on the recognition and management of this condition. MFMs can also aid in the antepartum diagnosis of abnormal placentation, which is an increasingly common risk factor for severe hemorrhage.
Collapse
Affiliation(s)
- Kathleen M Antony
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, 6651 Main St, 10th Floor, Houston, TX 77030, USA.
| | | |
Collapse
|
14
|
A local hemostatic agent for the management of postpartum hemorrhage due to placenta previa and placenta accreta: a cross-sectional study. Arch Gynecol Obstet 2013; 288:543-9. [PMID: 23532388 DOI: 10.1007/s00404-013-2812-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/13/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the use of a local hemostatic agent (LHA) for the management of postpartum hemorrhage (PPH) due to bleeding of the placental bed in patients taken to caesarean section at Fundación Santa Fe de Bogotá University Hospital. SAMPLE A total of 41 pregnant women who had a caesarean section and developed PPH. METHODS A cross-sectional study. Analysis of all cases of PPH during caesarean section presented from 2006 up to and including 2012 at Fundación Santa Fe de Bogotá University Hospital. MAIN OUTCOME MEASURE Emergency hysterectomy due to PPH. RESULTS The proportion of hysterectomies was 5 vs. 66 % for the group that received and did not receive management with a LHA respectively (PR 0.07, CI 95 % 0.01-0.51 p < 0.01). For the group managed without a LHA, 80 % of patients needed hemoderivatives transfusion vs. 20 % of patients in the group managed with a LHA (PR 0.24, CI 95 % 0.1-0.6 p < 0.01). A reduction in the mean days of hospitalization in addition to a descent in the proportion of patients admitted to the intensive care unit (ICU) was noticed when comparing the group that received a LHA versus the one that did not. CONCLUSION An inverse association between the use of a LHA in patients with PPH due to bleeding of the placental bed and the need to perform an emergency obstetric hysterectomy was observed. Additionally there was a significant reduction in the mean duration of hospital stay, use of hemoderivatives and admission to the ICU.
Collapse
|
15
|
RIISKJAER MADS, PETERSEN OLAVB, ULDBJERG NIELS, HVIDMAN LONE, HELMIG RIKKEB, FORMAN AXEL. Feasibility and clinical effects of laparoscopic abdominal cerclage: an observational study. Acta Obstet Gynecol Scand 2012; 91:1314-8. [DOI: 10.1111/aogs.12001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Uterine healing after therapeutic intrauterine administration of TachoSil (hemostatic fleece) in cesarean section with postpartum hemorrhage caused by placenta previa. J Pregnancy 2012; 2012:635683. [PMID: 22619722 PMCID: PMC3348634 DOI: 10.1155/2012/635683] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/01/2012] [Indexed: 11/17/2022] Open
Abstract
Background. Application of hemostatic fleece (TachoSil) directly onto the bleeding surfaces of the lower uterine segment has been used to obtain hemostasis during cesarean section caused by placenta previa. Methods. Eleven of 15 patients treated with TachoSil for excessive postpartum haemorrhage due to placenta previa were enrolled. An evaluation of the cesarean section scar by transvaginal ultrasound, the uterine cavity and endometrium by hysteroscopy, and the endometrium by biopsy were made. The main outcome measures were intrauterine adhesions, recovery of endometrium at the site of TachoSil application, visible remnants of TachoSil, and scar healing. Results. Eight patients had small remnants of TachoSil in the uterine cavity together with signs of resorption. All had a normal endometrial mucosa, and none had adhesions in the uterine cavity. All cesarean section scars were healed without defects. Conclusion. TachoSil did not seem to impair healing of the endometrium or scar formation in the uterus after intrauterine application. Resorption of TachoSil seems to progress individually. Intrauterine treatment with TachoSil is a valuable supplement to the traditional treatment of post partum haemorrhage and may help retain reproductive capability. This is a small study, and it will require more studies to confirm the reproducibility.
Collapse
|