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Hargett SE, Leslie EF, Chapa HO, Gaharwar AK. Animal models of postpartum hemorrhage. Lab Anim (NY) 2024; 53:93-106. [PMID: 38528231 DOI: 10.1038/s41684-024-01349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/26/2024] [Indexed: 03/27/2024]
Abstract
Postpartum hemorrhage (PPH)-heavy bleeding following childbirth-is a leading cause of morbidity and mortality worldwide. PPH can affect individuals regardless of risks factors and its incidence has been increasing in high-income countries including the United States. The high incidence and severity of this childbirth complication has propelled research into advanced treatments and alternative solutions for patients facing PPH; however, the development of novel treatments is limited by the absence of a common, well-established and well-validated animal model of PPH. A variety of animals have been used for in vivo studies of novel therapeutic materials; however, each of these animals differs considerably from the anatomy and physiology of a postpartum woman, and the methods used for achieving a postpartum hemorrhagic condition vary widely. Here we critically evaluate the various animal models of PPH presented in the literature and propose additional and alternative methods for modeling PPH in in vivo studies. We highlight how current animal models successfully or unsuccessfully mimic the anatomy and physiology of a postpartum woman and how this may impact treatment development. We aim to equip researchers with the necessary background information to select appropriate animal models for their research related to PPH solutions, while supporting the goals of refinement, reduction and replacement (3Rs) in preclinical animal studies.
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Affiliation(s)
- Sarah E Hargett
- Department of Biomedical Engineering, College of Engineering, Texas A&M University, College Station, TX, USA
| | - Elaine F Leslie
- Department of Biomedical Engineering, College of Engineering, Texas A&M University, College Station, TX, USA
| | - Hector O Chapa
- Medical Education, College of Medicine, Texas A&M University, Bryan, TX, USA
| | - Akhilesh K Gaharwar
- Department of Biomedical Engineering, College of Engineering, Texas A&M University, College Station, TX, USA.
- Interdisciplinary Program in Genetics and Genomics, Texas A&M University, College Station, TX, USA.
- Department of Material Science and Engineering, College of Engineering, Texas A&M University, College Station, TX, USA.
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, USA.
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Verma A, Sharma G, Kashyap M. A Retrospective Analysis of Emergency Obstetric Hysterectomy: A Life-Saving Intervention. Cureus 2023; 15:e46758. [PMID: 37946885 PMCID: PMC10632065 DOI: 10.7759/cureus.46758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Abstract
Introduction Emergency obstetric hysterectomy (EOH) is a lifesaving procedure that plays a critical role in managing life-threatening obstetric emergencies. In our study, we sought to evaluate the incidence, indications, risk factors and maternal as well as fetal outcomes associated with EOH. Also, the study was conducted to review the operative experiences and trend of emergency hysterectomies done for various indications over a period of two years in our tertiary care center. Methods The present hospital-based retrospective analytical study was conducted in the Department of Obstetrics and Gynecology, L.L.R.M. Medical College, Meerut, between March 2021 to February 2023. All women who delivered within or outside the institute undergoing obstetric hysterectomy were included in our study. Out of a total of 7743 deliveries, 46 EOH cases were found. The data of these 46 EOH deliveries were collected and analyzed after issuing ethical clearance by the Institutional Ethical Committee of L.L.R.M. Medical College, Meerut. Results During the two-year study period, 46 EOH were performed out of 7743 deliveries making an incidence of 0.504 EOH per 100 deliveries. Most of the cases were of multiparous women in the age group of 25 to 35 years (78%). The majority, 43.5% cases belonged to placenta accreta spectrum (PAS), followed by ruptured uterus (30.5%) and postpartum hemorrhage (PPH) (26%). The most frequent preoperative complication seen in EOH was severe anemia (29, 63%). Intraoperative bladder injury was seen in four cases, along with one case of ureteric injury. Postoperatively, cases were shown to have acute hemorrhagic shock (54.3%), disseminated intravascular coagulation (DIC), septicemia, wound infection, acute renal failure (ARF), hepatic encephalopathy and psychosis. Four maternal mortalities were observed in our study. Conclusion EOH is a necessary operative procedure in many obstetric emergencies including PAS and PPH. Despite intra-operative risk and possible postoperative complications, it remains a potentially life-saving procedure. Thus various surgeries for PAS and PPH should be the integral part of postgraduate trainings to save the lives of mothers and to reduce the maternal mortality.
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Affiliation(s)
- Aruna Verma
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
| | - Garima Sharma
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
| | - Monika Kashyap
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
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Barinov S, Di Renzo GC, Kadtsyna Т, Nadezhina Е, Lazareva О, Kochev D. Management of large paravaginal hematomas with the Zhukovsky vaginal catheter. Int J Gynaecol Obstet 2023; 163:148-153. [PMID: 37246460 DOI: 10.1002/ijgo.14889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/07/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To ameliorate the treatment of large paravaginal hematomas postpartum using the Zhukovsky vaginal catheter. METHODS A retrospective, controlled study including puerperas with large paravaginal hematomas. To assess the effectiveness of the proposed treatment, a group of patients underwent traditional obstetric surgery. A second group of puerperas underwent an integrated approach: the surgical stage (pararectal incision) and the application of the Zhukovsky vaginal catheter. The effectiveness of treatment was assessed according to the following criteria: blood loss volume and hospital admission time. RESULTS In total, 30 puerperas were included in the study; 15 in each treatment group. Large paravaginal hematomas were reported most often in primiparas (50.0%), in 36.7% were combined with rupture of the vagina and the cervix, and in 10.0% of cases an episiotomy was performed during delivery. In 40.0% of primiparas, the blood loss volume was more than 1000 mL, whereas in multiparous and in multiple pregnancies, blood loss did not exceed 1000 mL (r = -0.49; P = 0.022). In 25.0% of puerperas with a blood loss of up to 1000 mL there were no obstetric injuries; in the group with a blood loss of more than 1000 mL, 83.3% of patients had obstetric injuries. An integrated approach reduced the blood loss volume (r = -0.22; P = 0.29), compared with the traditional surgery, and reduced the hospital admission time from 12 (11.5; 13.5) days to 9 (7.5; 10.0) days (P < 0.001). CONCLUSION In patients with large paravaginal hematomas treated by an integrated approach we reported a decrease in bleeding, less risk of postoperative complications, and a reduction in the time of the hospital stay.
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Affiliation(s)
- Sergey Barinov
- Omsk State Medical University, Ministry of Health of Russia, Omsk, Russia
| | - Gian Carlo Di Renzo
- Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Тatyana Kadtsyna
- Omsk State Medical University, Ministry of Health of Russia, Omsk, Russia
| | - Еvgenia Nadezhina
- Regional Perinatal Centre, Regional Perinatal Centre, Regional Clinical Hospital, Omsk, Russia
| | - Оksana Lazareva
- Omsk State Medical University, Ministry of Health of Russia, Omsk, Russia
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Lu T, Wu M, Wang Y, Li M, Li H, Zhang F, Yi Y, Zhu M, Zhao X. Association of MRI Features and Adverse Maternal Outcome in Patients With Placenta Accreta Spectrum Disorders After Abdominal Aortic Balloon Occlusion. J Magn Reson Imaging 2023; 58:817-826. [PMID: 36606736 DOI: 10.1002/jmri.28591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND MRI features may be associated with adverse maternal outcome in patients with placenta accreta spectrum (PAS) disorders even with abdominal aortic balloon occlusion (AABO). PURPOSE This study aimed to identify risk factors of MRI for association with adverse maternal outcome in patients with PAS disorders after AABO. STUDY TYPE Retrospective. POPULATION Clinical and MRI features of 80 patients were retrospectively reviewed from October 2016 to August 2021. A total of 40 patients had adverse maternal outcomes including intrapartum/peripartum bleeding >1000 mL and/or emergency hysterectomy after AABO. SEQUENCE Half-Fourier acquisition single-shot turbo spin echo and gradient echo imaging True fast imaging with steady-state precession (True-FISP) at 1.5T MR scanner. ASSESSMENT MRI features were evaluated by three radiologists and were tested for any association with adverse maternal outcome. STATISTICAL TESTS Interobserver agreement was calculated with kappa (k) statistics. Association between MRI features and adverse maternal outcomes were evaluated by univariate and multivariate analyses. A nomogram was constructed based on the logistic regression. RESULTS The interobserver agreement ranged from fair to substantial (k = 0.379-0.783). Multivariate analyses revealed that short cervical length (OR: 4.344), abnormal intraplacental vascularity (OR: 6.005), placental bulge (OR: 9.085), and myometrial interruption (OR: 9.550) were independent risk factors for adverse maternal outcomes. The combination of four risk factors together demonstrated the highest AUC of 0.851 (95% CI 0.769-0.933) with a sensitivity and specificity of 77.5% and 72.5%, respectively and then a nomogram composed of the above four risk factors was constructed to represent the probability of adverse maternal outcome. DATA CONCLUSION The nomogram demonstrated the association between MRI features and patient's poor outcome after undergoing AABO and C-section delivery for PAS. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mingpeng Wu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mou Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hang Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng Zhang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Yi
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Meilin Zhu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinyi Zhao
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Kwak JW, Cho SB, Sung DJ, Kang CH. Effectiveness of transarterial embolisation for intractable postpartum haemorrhage in a disseminated intravascular coagulation state, despite emergency hysterectomy. Clin Radiol 2023; 78:55-60. [PMID: 36307234 DOI: 10.1016/j.crad.2022.08.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE We evaluated the effectiveness of transarterial embolization (TAE) for intractable postpartum hemorrhage in patients with disseminated intravascular coagulation (DIC) despite emergency hysterectomy. MATERIALS AND METHODS We retrospectively assessed TAE performed after emergency hysterectomy in 15 patients between July 2008 and January 2022. Underlying condition, technical success, clinical success, angiographic findings, laboratory findings, pregnancy-modified DIC score (The International Society on Thrombosis and Haemostasis), blood transfusion, ICU (Intensive care unit) admission day, hospital day, in-hospital mortality, and long-term sequelae were evaluated. RESULTS All patients were diagnosed with DIC before embolization, with a 43.9 mean DIC score. All patients showed positive angiographic findings for active bleeding. Thirty-eight bleeding arteries were confirmed. The remnant uterine artery (n=25) was the most common focus of persistent bleeding, followed by the cervicovaginal artery (n=6), pudendal artery (n=3), obturator artery (n=2), vesical artery (n=1), and unspecified artery from the internal iliac artery (n=1). Technical and clinical success rates were 100% (15/15) and 93.3% (14/15), respectively. Mean nadir hemoglobin (Hb) level before embolization was 4.9 g/dL. All patients underwent massive transfusion before embolization (mean 33.2 packs of RBC). Postoperatively, a smaller amount of blood was transfused than before the procedure (mean 10.6 packs of RBC). Mean nadir Hb level after embolization was 8.2 g/dL. There was one instance each of in-hospital death, hypoxic brain damage, and ischemic acute kidney injury. CONCLUSION Despite hysterectomy for postpartum bleeding, there could be multiple residual or uncontrolled bleeding foci, especially in case of DIC, for which TAE could be an effective treatment.
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Kallianidis AF, Rijntjes D, Brobbel C, Dekkers OM, Bloemenkamp KWM, van den Akker T. Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 141:35-48. [PMID: 36701608 DOI: 10.1097/AOG.0000000000005022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the incidence, indications, risk factors, outcomes, and management of emergency peripartum hysterectomy globally and to compare outcomes among different income settings. DATA SOURCES PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, Web of Science, and Emcare databases up to December 10, 2021. METHODS OF STUDY SELECTION Update of a systematic review and meta-analysis (2016). Studies were eligible if they reported the incidence of emergency peripartum hysterectomy, defined as surgical removal of the uterus for severe obstetric complications up to 6 weeks postpartum. Title and abstract screening and full-text review were performed using Endnote data-management software. Of 8,775 articles screened, 26 were included that were published after 2015, making the total number of included studies 154. A subanalysis was performed for the outcomes of interest per income setting. TABULATION, INTEGRATION, AND RESULTS The meta-analysis included 154 studies: 14,409 emergency peripartum hysterectomies were performed in 17,127,499 births in 42 countries. Overall pooled incidence of hysterectomy was 1.1 per 1,000 births (95% CI 1.0-1.3). The highest incidence was observed in lower middle-income settings (3/1,000 births, 95% CI 2.5-3.5), and the lowest incidence was observed in high-income settings (0.7/1,000 births, 95% CI 0.5-0.8). The most common indications were placental pathology (38.0%, 95% CI 33.9-42.4), uterine atony (27.0%, 95% CI 24.6-29.5), and uterine rupture (21.2%, 95% CI 17.8-25.0). In lower middle-income countries, uterine rupture (44.5%, 95% CI 36.6-52.7) was the most common indication; placental pathology (48.4%, 95% CI 43.5-53.4) was most frequent in high-income settings. To prevent hysterectomy, uterotonic medication was used in 2,706 women (17%): 53.2% received oxytocin, 44.6% prostaglandins, and 17.3% ergometrine. Surgical measures to prevent hysterectomy were taken in 80.5% of women, the most common being compressive techniques performed in 62.6% (95% CI 38.3-81.9). The most common complications were febrile (29.7%, 95% CI 25.4-34.3) and hematologic (27.5%, 95% CI 20.4-35.9). The overall maternal case fatality rate was 3.2 per 100 emergency peripartum hysterectomies (95% CI 2.5-4.2) and was higher in lower middle-income settings (11.2/100 emergency peripartum hysterectomies 95% CI 8.9-14.1) and lower in high-income settings (1.0/100 emergency peripartum hysterectomies 95% CI 0.6-1.6). CONCLUSION Substantial differences across income settings exist in the incidence of emergency peripartum hysterectomy. Women in lower-income settings have a higher risk of undergoing emergency peripartum hysterectomy and suffer more procedure-related morbidity and mortality. The frequency of emergency peripartum hysterectomy is likely to increase in light of increasing cesarean delivery rates.
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Sallée C, Margueritte F, Marquet P, Piver P, Aubard Y, Lavoué V, Dion L, Gauthier T. Uterine Factor Infertility, a Systematic Review. J Clin Med 2022; 11:jcm11164907. [PMID: 36013146 PMCID: PMC9410422 DOI: 10.3390/jcm11164907] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Uterine factor infertility (UFI) is defined as a condition resulting from either a complete lack of a uterus or a non-functioning uterus due to many causes. The exact prevalence of UFI is currently unknown, while treatments to achieve pregnancy are very limited. To evaluate the prevalence of this condition within its different causes, we carried out a worldwide systematic review on UFI. We performed research on the prevalence of UFI and its various causes throughout the world, according to the PRISMA criteria. A total of 188 studies were included in qualitative synthesis. UFI accounted for 2.1 to 16.7% of the causes of female infertility. We tried to evaluate the proportion of the different causes of UFI: uterine agenesia, hysterectomies, uterine malformations, uterine irradiation, adenomyosis, synechiae and Asherman syndrome, uterine myomas and uterine polyps. However, the data available in countries and studies were highly heterogenous. This present systematic review underlines the lack of a consensual definition of UFI. A national register of patients with UFI based on a consensual definition of Absolute Uterine Factor Infertility and Non-Absolute Uterine Factor Infertility would be helpful for women, whose desire for pregnancy has reached a dead end.
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Affiliation(s)
- Camille Sallée
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
- Correspondence: ; Tel.: +33-555-055-555
| | - François Margueritte
- Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, 78103 Poissy, France
| | - Pierre Marquet
- Department of Pharmacology and Toxicology, Centre Hospitalier Universitaire de Limoges, 87042 Limoges, France
| | - Pascal Piver
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Yves Aubard
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Tristan Gauthier
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
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Abrar S, Abrar T, Sayyed E, Naqvi SA. Ruptured uterus: Frequency, risk factors and feto-maternal outcome: Current scenario in a low-resource setup. PLoS One 2022; 17:e0266062. [PMID: 35395033 PMCID: PMC8993016 DOI: 10.1371/journal.pone.0266062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/12/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Pakistan is among the countries with the highest maternal death rates. Obstetric hemorrhage accounts for 41% of these deaths. Uterine rupture is a grave obstetric emergency with high maternal and neonatal morbidity and mortality. It is important to identify its frequency and associated risk factors to formulate programs for its prevention and management. This study aimed to assess the frequency, associated risk factors, fetomaternal outcomes, and management of women with the ruptured uterus at our hospital. Material and methods It was a retrospective study of 206 women to review data collected from cases of uterine rupture managed at the WCTH Bannu, Pakistan from October 2016 to October 2018. A structured proforma was designed and used to extract data from operating theatre registers and the hospital medical records. In our hospital, there is a strong system of maintaining all information of the patients related to demographics, obstetric information, operative notes, and postoperative course during their hospital stay in the patient’s charts. Detailed information on operative procedures is further maintained in the operation theater register and all these registers are checked in the weekly statistical meetings to ensure proper documentation. Data was entered and analyzed in SPSS package version 21 (IBM Corp.; Armonk, NY, USA). Frequency and percentages were calculated for the categorical variables. For inferential statistics, chi-square or Fischer exact tests were used. A p-value of < 0.05 was considered statistically significant. Results The overall incidence of the ruptured uterus was 1.71%. The important etiological factors were grand multiparity 62 (35.2%), obstructed/neglected labour 58 (32.9%), injudicious use of Oxytocin 56 (31.8%) and prostaglandins 26 (14.7%), previous cesarean section 35 (19.8%) and previous pelvic surgery (0.5%). Hysterectomy was done in 80.6% of cases, 34 (19.2%) patients underwent uterine repair and 4.5% had bladder repair. The mortality rate was 21%, mainly due to irreversible shock or disseminated intravascular coagulation. Perinatal mortality was 91.4%. Duration of surgery more than two hours and presentation to the hospital at night time was significantly associated with poor maternal outcome (p = 0.00). Conclusion Uterine rupture is a preventable obstetric emergency associated with high fetomaternal morbidity and mortality. The main causes were grand multigravidity, obstructed labour, previous C-sections and injudicious use of oxytocin and prostaglandins. Women with prolonged surgery and admission at night time had a poor maternal outcome.
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Affiliation(s)
- Saida Abrar
- Department of Gynecology and Obstetrics, Lady Reading Hospital, Khyber Medical College, Peshawar, Pakistan
- * E-mail:
| | - Tahira Abrar
- Department of Gynecology and Obstetrics, Lady Reading Hospital, Khyber Medical College, Peshawar, Pakistan
| | | | - Sidra Ali Naqvi
- Department of Pain Clinic, Shifa International Hospital, Islamabad, Pakistan
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Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D, Lloyd I, Chandraharan E, Miller S, Burke T, Ossanan G, Andres Carvajal J, Ramos I, Hincapie MA, Loaiza S, Nasner D. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet 2022; 157 Suppl 1:3-50. [PMID: 35297039 PMCID: PMC9313855 DOI: 10.1002/ijgo.14116] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Maria Fernanda Escobar
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Tygerberg Hospital, Cape Town, South Africa
| | - Eythan R Barnea
- Society for Investigation or Early Pregnancy (SIEP), New York, New York, USA
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Diana Ramasauskaite
- Center of Obstetrics and Gynecology, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Isabel Lloyd
- Department of Obstetrics and Gynecology, Universidad de Panamá, Panama City, Panamá.,Hospital Santo Tomas, Panama City, Panamá
| | - Edwin Chandraharan
- Department of Obstetrics and Gynecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Thomas Burke
- Division of Global Health and Human Rights, Massachusetts General Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, USA
| | - Gabriel Ossanan
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Javier Andres Carvajal
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Isabella Ramos
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Maria Antonia Hincapie
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Sara Loaiza
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Daniela Nasner
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | -
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia
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Silva FX, Parpinelli MA, Oliveira-Neto AF, do Valle CR, Souza RT, Costa ML, Correia MDT, Katz L, Payne B, Ryan H, von Dadelszen P, Cecatti JG. Prognostic Value of an Estimate-of-Risk Model in Critically Ill Obstetric Patients in Brazil. Obstet Gynecol 2022; 139:83-90. [PMID: 34915534 DOI: 10.1097/AOG.0000000000004619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
The CIPHER (Collaborative Integrated Pregnancy High-Dependency Estimate of Risk) prognostic model was not predictive of risk of death, prolonged organ support, or lifesaving intervention among critically ill patients in Brazil. To externally validate the CIPHER (Collaborative Integrated Pregnancy High-Dependency Estimate of Risk) prognostic model for pregnant and postpartum women admitted to the intensive care unit.
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Castro F, Ejzenberg D, Pinheiro RS, Ducatti L, Arantes RM, Nacif L, Waisberg D, Martino RB, Santos VR, Soares JM, Baracat EC, D'Albuquerque LAC, Andraus W, Canaval H, Canaval G, Rico JM, Vanin A. Uterus procurement from deceased donor for transplantation. Transpl Int 2021; 34:2570-2577. [PMID: 34668605 DOI: 10.1111/tri.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/06/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
Women with absolute uterine factor infertility cannot get pregnant. The current experience in uterine transplantation is limited and the use of a deceased donor uterus in this area is incipient after some initial unsuccessful attempts. The birth of healthy babies through this modality in four different centers has given a new impetus to the use of this transplantation technique. We aimed to develop a technique for uterus procurement and preparation for transplantation from a brain dead donor. Fifteen uteri were retrieved from multi-organ donor patients, 10 of these were used in bench surgeries with the proposed technique. All procedures were performed after obtaining family's consent. This study allowed the clinical use of two of the 15 organs that were procured for transplantation. One of these organs resulted in the first live birth worldwide using a uterus transplanted from a deceased donor, a landmark in reproductive medicine. Another outcome was the optimization of the surgical technique involving less manipulation of the uterine vascular pedicles. The success of this novel technique suggests that the proposed model can be replicated and optimized further to facilitate the transplantation of uterus from deceased donors.
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Affiliation(s)
- Felipe Castro
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.,Department of Gynecology and Obstetrics, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.,Department of Gynecology and Obstetrics, Clinica Imbanaco, Cali, Colombia.,Department of Liver Transplantation, Clinica Imbanaco, Cali, Colombia
| | - Dani Ejzenberg
- Department of Gynecology and Obstetrics, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rafael S Pinheiro
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Liliana Ducatti
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rubens M Arantes
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Lucas Nacif
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel Waisberg
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rodrigo B Martino
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Vinicius R Santos
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Jose Maria Soares
- Department of Gynecology and Obstetrics, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Edmund Chada Baracat
- Department of Gynecology and Obstetrics, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Augusto Carneiro D'Albuquerque
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Wellington Andraus
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Hoover Canaval
- Department of Gynecology and Obstetrics, Clinica Imbanaco, Cali, Colombia
| | - Gustavo Canaval
- Department of Gynecology and Obstetrics, Clinica Imbanaco, Cali, Colombia
| | - Juan Manuel Rico
- Department of Liver Transplantation, Clinica Imbanaco, Cali, Colombia
| | - Anabel Vanin
- Department of Liver Transplantation, Clinica Imbanaco, Cali, Colombia
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Win SS, Lasimbang HB, Lynn AUng SN, Yeap TB. How B-Lynch suture and bilateral internal iliac artery ligation saved the uterus of a young patient with severe postpartum haemorrhage. BMJ Case Rep 2021; 14:e244226. [PMID: 34385222 PMCID: PMC8362738 DOI: 10.1136/bcr-2021-244226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/03/2022] Open
Abstract
Obstetric haemorrhage is the leading cause of maternal death worldwide (27.1%) and more than 66% of its deaths were classified as postpartum haemorrhage (PPH). The most common cause of PPH is uterine atony. Obstetrician should be skillful in managing obstetric emergencies; especially pertaining to PPH. Application of the B-Lynch suture on an atonic uterus is one of the surgical options in PPH patients who wish to conserve the uterus and it has a very high success rate.We present a primigravida patient who developed massive primary PPH followed by disseminated intravascular coagulation, which was successfully managed with B-Lynch suture and bilateral internal iliac artery ligation. We described in detail regarding the management of massive PPH and application of these surgical procedures on the atonic uterus with an attempt to preserve the uterus and future fertility in this young patient.
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Affiliation(s)
- San San Win
- Reproductive Health Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Helen Benedict Lasimbang
- Reproductive Health Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Sai Nay Lynn AUng
- Reproductive Health Department, Mahidol University Institute for Population and Social Research, Nakorn Pathom, Thailand
| | - Tat Boon Yeap
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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13
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Wahono WT, Putri A, Saroyo YB, Nugroho AJ, Sally R, Simanjuntak SP, Samuel. A case of third degree hemorrhagic shock due to total subacute uterine inversion after delivery. Med J Indones 2021. [DOI: 10.13181/mji.cr.203862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Uterine inversion is a rare, but life-threatening obstetric emergency. We describe a case of total subacute uterine inversion in settings with limited resources. A multiparous (P4) 29-year-old woman with history of delivery assisted by a traditional birth attendant who used the fundal pressure technique 4 days before admission was referred due to postpartum hemorrhage. She had low blood pressure, tachycardia, and lethargic. A protruding mass from the vaginal introitus with active bleeding was visible. She diagnosed with third degree hemorrhagic shock due to total subacute uterine inversion. Resuscitation was initiated immediately and manual uterine repositioning was performed under general anesthesia. After two failed attempts, a laparotomy was performed to apply traction to the round ligaments and an incision on the cervical ring by using Allis clamps. The inversion was resolved. Next, subtotal hysterectomy was done to stop bleeding and infection.
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Briones JR, Talungchit P, Thavorncharoensap M, Chaikledkaew U. Economic evaluation of carbetocin as prophylaxis for postpartum hemorrhage in the Philippines. BMC Health Serv Res 2020; 20:975. [PMID: 33106169 PMCID: PMC7586682 DOI: 10.1186/s12913-020-05834-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 10/20/2020] [Indexed: 01/28/2023] Open
Abstract
Background The World Health Organization (WHO) recommends oxytocin as the drug of choice for postpartum hemorrhage (PPH) prevention. However, the WHO has also recently considered carbetocin for PPH prevention, but only if carbetocin were a cost-effective choice in the country. Consequently, we determined the cost-effectiveness and budgetary impact of carbetocin against oxytocin in the Philippines. Methods A cost-utility analysis using a decision tree was done to compare the costs and outcomes of carbetocin with oxytocin for PPH prophylaxis among women undergoing either vaginal delivery (VD) or cesarean section (CS) in a six-week time horizon using a societal perspective. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Additionally, budget impact analysis was conducted using a governmental perspective. Results were presented as incremental cost-effectiveness ratio (ICER) using a 2895 United States dollar (USD) per quality adjusted life year (QALY) gained as the ceiling threshold in the Philippines. Results Carbetocin was not cost-effective given the listed price of carbetocin at 18 USD. Given a societal perspective, the ICER values of 13,187 USD and over 40,000 USD per QALY gained were derived for CS and VD, respectively. Moreover, the ICER values were sensitive to the risk ratio of carbetocin versus oxytocin and carbetocin price. On budget impact, the five-year total budget impact of a drug mix of carbetocin and oxytocin was 25.54 million USD (4.23 million USD for CS and 21.31 million USD for VD) compared with ‘only oxytocin’ scenario. Conclusion Carbetocin is not a cost-effective choice in PPH prevention for both modes of delivery in the Philippines, unless price reduction is made. Our findings can be used for evidence-informed policies to guide coverage decisions on carbetocin not only in the Philippines but also in other low and middle-income countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05834-x.
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Affiliation(s)
- Jamaica Roanne Briones
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
| | - Pattarawalai Talungchit
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand.,Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand.,Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayudhaya Rd., Phayathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand. .,Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayudhaya Rd., Phayathai, Ratchathewi, Bangkok, 10400, Thailand.
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15
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Shahid R, Abbas H, Mumtaz S, Bari MF, Ahmed N, Memon S, Raja T, Dawani K. Emergency Obstetric Hysterectomy, the Histopathological Perspective: A Cross-Sectional Study From a Tertiary Care Hospital. Cureus 2020; 12:e9094. [PMID: 32789042 PMCID: PMC7417067 DOI: 10.7759/cureus.9094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Emergency obstetric hysterectomy (EOH) is a life-saving procedure which involves the surgical removal of uterus and is usually performed for uncontrollable maternal hemorrhage when all other conservative management has failed. This study was conducted to evaluate the histopathological findings in the EOH specimen received in the department of pathology. Methods This hospital-based cross-sectional study was conducted in the Histopathology Laboratory, Department of Pathology, and Dow Medical College (DMC) from September 2017 to December 2018. The histopathological findings in the EOH specimen were recorded and data was analyzed. Results Ninety-six cases of EOH were received. The incidence of emergency obstetric hysterectomy was 58.37/10,000 deliveries. The mean age of patients was 30.59 years (range 20-45 years). The main histopathological findings were placenta accreta spectrum in 61 (63.54%) cases, cervical tear in eight (8.33%), uterine rupture in seven (7.29%) and endomyometritis in six (6.25%) cases. In the placenta accreta spectrum, placenta accreta was the most frequent diagnosis in 23 (23.96%) of cases, placenta increta in 17 (17.71%), placenta percreta in 10 (10.42%) cases. Seven (7.29%) cases of placenta percreta and four (4.17%) cases of placenta accreta were diagnosed in association with placenta previa. Twenty placentas were received with the hysterectomies, of these eight (40%) placentas showed infarction and six (30%) had intervillous fibrin, both findings were suggestive of uteroplacental insufficiency, while three (15%) placentas had normal histology. Ovaries were received with the hysterectomies in 11 (11.46%) cases. Mature cystic teratoma was diagnosed in two (2.08%) ovaries while the majority of ovaries were normal on histology. Conclusion Placenta accreta spectrum is the leading histopathological finding in the EOH specimen. Regular antenatal follow-up and radiological examination of pregnant women is inferred to prevent obstetric complications and near-miss event of EOH. Further research is recommended to confirm the findings in placenta. Ovarian conservation is suggested in patients undergoing EOH with no clinical and surgical indication for oophorectomy.
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Affiliation(s)
- Ruqaiya Shahid
- Pathology, Dow International Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Hina Abbas
- Hematology, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Shazia Mumtaz
- Pathology, Dow International Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Muhammad Furqan Bari
- Pathology, Dow International Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Naseem Ahmed
- Pathology, Dow University of Health Sciences, Karachi, PAK
| | - Shaima Memon
- Pathology, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Tazeen Raja
- Pathology, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Kartar Dawani
- Pathology, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
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Abstract
Severe obstetric hemorrhage is a catastrophic event and represents the main cause of maternal morbidity and mortality worldwide. The elevated mortality rate due to hemorrhage is associated with metabolic complications and organ hypoperfusion that may trigger a state of irreversible coagulopathy. Thus, the use of conventional measures to control bleeding frequently generates a vicious cycle in which the patient continues bleeding (prolonging surgical times). Damage-control surgery has proven to be feasible and effective in the context of obstetric hemorrhage. It combines surgical and resuscitative measures that generate successful results in the control of refractory bleeding, ultimately decreasing mortality in patients being in critical condition.
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Affiliation(s)
- Javier A Carvajal
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Isabella Ramos
- Faculty of Health Sciences, ICESI University, Cali, Colombia
| | - Juan P Kusanovic
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Hospital Sótero del Río, Santiago, Chile.,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María F Escobar
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
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17
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Chen L, Wu B, Han Q, Yan J. Clinical analysis of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage. J Int Med Res 2019; 48:300060519879294. [PMID: 31662015 PMCID: PMC7607188 DOI: 10.1177/0300060519879294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This study was performed to explore the causes and clinical characteristics
of emergency exploratory laparotomy in patients with intractable postpartum
hemorrhage. Methods This retrospective study was performed from January 2004 to December 2017.
Patients with intractable postpartum hemorrhage were grouped according to
the initial pathogenesis as determined by exploratory laparotomy: uterine
atony, placental factors, coagulation dysfunction, or uterine rupture. Results This study involved 72 patients who underwent emergency exploratory
laparotomy, accounting for 0.04% of total deliveries. Uterine preservation
surgery and hysterectomy were performed in 31 and 41 patients, respectively.
Abnormal events upon returning to the ward were primarily vaginal hemorrhage
and pelvic hematoma. The frequency of uterine artery ligation was lower in
the hysterectomy group than uterine preservation group. The prothrombin
activity level, fibrinogen level, and platelet count before surgery were
lower in the hysterectomy group than uterine preservation group. The
international normalized ratio and activated partial thromboplastin time
were higher in the hysterectomy group than uterine preservation group. In
total, 44 patients developed complications. Conclusion Placental implantation is a primary cause of hysterectomy after emergency
laparotomy. However, the possibility of postpartum hemorrhage caused by
coagulation disorders should not be ignored.
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Affiliation(s)
- Lichun Chen
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Baohua Wu
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Qing Han
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Jianying Yan
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
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18
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Giampaolino P, Della Corte L, Apparente P, Bifulco G. Uterine arteries prophylactic occlusion balloon placement in pregnancies with placenta praevia. MINIM INVASIV THER 2019; 30:115-119. [PMID: 31642721 DOI: 10.1080/13645706.2019.1679838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION To evaluate the feasibility of uterine arteries prophylactic occlusion balloon placement (POBP) to reduce hemorrhagic complications associated with placenta praevia. MATERIAL AND METHODS A retrospective analysis was carried out from January 2014 to November 2018. Only women with a diagnosis of placenta praevia and gestational age at delivery between 33 and 40 weeks were included. All women were diagnosed using transvaginal ultrasound scan (TVS) and confirmed with magnetic resonance imaging (MRI). All women underwent uterine arteries POBP before caesarean delivery (CD). All patients underwent clinical and instrumental follow-up with semestral outpatient TVS for 2 years after the surgery. RESULTS Forty-eight pregnant women were recruited and analyzed. 32/48 patients (66%) had positive anamnesis for previous CDs. Mean blood loss was 510 ± 222 mL. 15/48 patients (31.6%) were supported with RBC concentrate transfusion. In 10 (20.8%) cases, an intrauterine haemostatic balloon (Bakri-Balloon, Cook Medical, Spencer, USA) was used to control the intra-operative hemorrhage. Hysterectomy was performed in eight cases (16.6%). No cases of hemodynamic instability or urinary complications were reported. No postoperative complications occurred. During follow-up, no long-term complications were observed and nine patients had a successful pregnancy. CONCLUSIONS Uterine arteries POPB is a promising technique that may be adopted in women with placenta praevia to prevent hemorrhagic complications.
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Affiliation(s)
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Piera Apparente
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Barinov SV, Medyannikova IV, Borisova AV, Tyrskaya YI, Savelieva IV, Shamina IV, Lazareva OV, Kadtsyna TV. The Usefulness of Zhukovsky Double Balloon in Obstetric Hemorrhage. Maternal-Fetal Medicine 2019; 1:10-7. [DOI: 10.1097/fm9.0000000000000002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Hussein AM, Kamel A, Elbarmelgy RA, Thabet MM, Elbarmelgy RM. Managing Placenta Accreta Spectrum Disorders (PAS) in Middle/Low-Resource Settings. Curr Obstet Gynecol Rep 2019. [DOI: 10.1007/s13669-019-00263-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Ordoñez CA, Manzano-Nunez R, Parra MW, Rasmussen TE, Nieto AJ, Herrera-Escobar JP, Fernandez P, Naranjo MP, García AF, Carvajal JA, Burgos JM, Rodriguez F, Escobar-Vidarte MF. Prophylactic use of resuscitative endovascular balloon occlusion of the aorta in women with abnormal placentation: A systematic review, meta-analysis, and case series. J Trauma Acute Care Surg 2018; 84:809-18. [PMID: 29401189 DOI: 10.1097/TA.0000000000001821] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND We describe intraoperative and postdischarge outcomes of a case series after the prophylactic use of resuscitative endovascular balloon occlusion of the aorta (REBOA) during elective cesarean delivery in pregnant women with morbidly adherent placenta (MAP). We furthermore performed a systematic review and meta-analysis to investigate the safety and effectiveness of the use of REBOA during elective cesarean delivery in pregnant women with MAP. METHODS Descriptive case series of REBOA (December 2015 to June 2017) used during elective cesarean delivery in pregnant women with MAP. The systematic review was conducted following PRISMA guidelines. We included studies involving pregnant women with a diagnosis of MAP who underwent an elective cesarean delivery with prophylactic REBOA placement. A meta-analysis was performed to assess the overall amount of transfusions and intraoperative hemorrhage of REBOA compared to NO-REBOA cases. RESULTS A total of 12 patients with MAP underwent elective cesarean delivery with REBOA deployment. The median (interquartile range) of packed red blood cells transfused during the first 24 hours following surgery was two units (0-3.5). The median (interquartile range) of intraoperative blood loss was 1,500 mL (900-2,750). At 28 days, all patients were alive, and no adverse outcomes were observed. Four articles were included in the systematic review and meta-analysis. These articles included a total of 441 patients. Quantitative synthesis (meta-analysis) found that the use of REBOA as prophylaxis for the prevention of major hemorrhage was associated with a lower amount of intraoperative hemorrhage (in milliliters) (weighted mean difference, -1,384.66; 95% confidence interval, -2,141.74 to -627.58) and lower requirements of blood products transfusions (in units) (weighted mean difference, -2.42; 95% confidence interval, -3.90 to -0.94). CONCLUSION We provide clinical data supporting the use of REBOA in the management of pregnant women with MAP undergoing elective cesarean delivery. Our findings demonstrate the feasibility of REBOA as a prophylactic intervention to improve outcomes in women at risk of catastrophic postpartum hemorrhage. LEVEL OF EVIDENCE Therapeutic study, level V; Systematic Review, level IV.
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22
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Brännström M, Dahm-Kähler P. Uterus transplantation and fertility preservation. Best Pract Res Clin Obstet Gynaecol 2019; 55:109-116. [DOI: 10.1016/j.bpobgyn.2018.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 01/19/2023]
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23
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Barinov SV, Medjannikova IV, Tirskaya YI, Chuprinin VD, Khilkevich EG, Savelyeva IV, Shamina IV, Borisova AV, Lazareva OV. The use of Zhukovsky vaginal and intrauterine balloons to improve the outcome of postpartum hysterectomies in patients with severe bleeding. J Matern Fetal Neonatal Med 2019; 33:2955-2960. [PMID: 30614315 DOI: 10.1080/14767058.2019.1566309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: To assess the efficacy of a Zhukovsky obstetric double balloon for improving outcomes in women undergoing hysterectomy for postpartum hemorrhage.Materials and methods: This was a randomized controlled study. Participants were divided into two groups to undergo insertion of a Zhukovsky obstetric double balloon prior to hysterectomy (n = 16) or conventional hysterectomy (n = 25).Results: The main reasons for major obstetric hemorrhage were placenta accreta (53.6%), uterine atony (26.8%), uteroplacental apoplexy (14.6%), and amniotic fluid embolism (4.8%). The use of a Zhukovsky obstetric double balloon during postpartum hysterectomy was associated with a 1.7-fold reduction in blood loss and a 2.3-fold reduction in blood loss > 2000 ml compared with conventional hysterectomy.Conclusion: The use of a Zhukovsky obstetric double balloon represents a potent tool for improvement of immediate outcomes of hysterectomy in women with severe postpartum bleeding.
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Affiliation(s)
- Sergey V Barinov
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Irina V Medjannikova
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Yuliya I Tirskaya
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Vladimir D Chuprinin
- Ministry of Health of Russia, National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Elena G Khilkevich
- Ministry of Health of Russia, National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Irina V Savelyeva
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Inna V Shamina
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Anna V Borisova
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Oksana V Lazareva
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
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