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Li GT, Liu YJ, Li XF. Anatomical retracting suture to stop postpartum hemorrhage from the lower uterine segment. Asian J Surg 2023; 46:594-595. [PMID: 35842389 DOI: 10.1016/j.asjsur.2022.06.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Guang-Tai Li
- Department of Obstetrics and Gynecology, Hebei Yanda Hospital, Langfang, Hebei Province, 065201, PR China.
| | - Ya-Jing Liu
- Department of Obstetrics and Gynecology, China Emergency General Hospital (China Meitan General Hospital), No. 29 Xibahe Nanli, Chaoyang District, Beijing, 100028, PR China
| | - Xiao-Fan Li
- Departments of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, 52 Fucheng Rd, Haidian District, Beijing, 100142, PR China
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Yin Y, Qu L, Jin B, Yang Z, Xia J, Sun L, Zhou X. Spiral Suture of the Lower Uterine Segment with Temporary Aortic Balloon Occlusion in Morbidly Adherent Placenta Previa Cases. Int J Womens Health 2022; 14:1161-1171. [PMID: 36046176 PMCID: PMC9422986 DOI: 10.2147/ijwh.s367654] [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] [Received: 03/23/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We aimed to investigate the combined effect of spiral suture of the lower uterine segment with intraoperative aortic balloon occlusion in morbidly adherent placenta previa cases. Patient and Methods This retrospective, single-center study involved patients from 2017 to 2020. The study considered 68 cases of morbidly adherent placenta previa cases from medical records retrospectively with age ranging from 23 to 42 years. Bilateral uterine artery embolization was performed, to control excessive bleeding. Perioperative blood loss, hysterectomy rate, amount of blood transfusion, balloon occlusion time, fetal and maternal radiation dose, and postpartum complications were assessed. Results A total of 68 patients underwent surgery. Hysterectomy was performed in three patients and uterine artery embolization in 21 patients. Of 53 patients who required blood transfusions, the amount of packed red blood cells given was 800 mL and the amount of plasma given was 400 mL. Median abdominal aortic balloon occlusion time was 17 minutes. Fetal and maternal radiation doses were 5 mGy and 12 mGy, respectively. One patient experienced surgery-related complications, a bladder injury. No major catheterization-related and postpartum complications were observed. Conclusion Fertility-sparing surgery for women with morbidly adherent placenta could include abdominal aortic balloon occlusion and spiral suture of lower uterine segment.
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Affiliation(s)
- Yin Yin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People's Republic of China
| | - Lin Qu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People's Republic of China
| | - Bai Jin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People's Republic of China
| | - Zhengqiang Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People's Republic of China
| | - Jinguo Xia
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People's Republic of China
| | - Lizhou Sun
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People's Republic of China
| | - Xin Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People's Republic of China
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Zhao H, Zhao X, Chen C, Tao Y, Guo R. Effects and Long-Term Outcomes of a Modified Triple-P Procedure in Patients With Severe PAS: A Retrospective Cohort Study. Front Med (Lausanne) 2022; 9:839716. [PMID: 35433716 PMCID: PMC9005881 DOI: 10.3389/fmed.2022.839716] [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] [Received: 12/20/2021] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background The distinguished Triple-P procedure has been reported as a conservative surgical alternative to peripartum hysterectomy for placental accreta spectrum (PAS). In this study, we modified the procedure combined with prophylactic abdominal aorta balloon occlusion and/or tourniquet and evaluated the effect and long-term outcomes. Methods This was a retrospective study involving pregnant patients with clinically confirmed severe PAS (including placenta increta and percreta) between January 1st, 2017 and June 30th, 2020 in the First Affiliated Hospital of Zhengzhou University. A total of 334 pregnant women were recruited in this study. The 142 women that were subjected to modified Triple P Procedure were regarded as the observation group while 194 pregnant women that were treated with other sutures were regarded as the control group. Demographic characteristics, placental accreta spectrum score (PAS score), estimated blood loss (EBL), operative time, blood transfusion rate and volume, neonatal weight, post-operative hospital stays and costs were evaluated. Short-term complications, including fever, hematoma, thrombus, bladder rupture and intensive care unit (ICU) transfer rate, as well as long-term outcomes including breast feeding, menstruation, intrauterine adhesion, and chronic abdominal pain among others were followed up in the outpatient clinic and by phone calls. Results For all cases, EBL was lower in the observation group than in the control group, 1,200 (687–1,812) ml and 1,300 (800–2,500) ml, respectively. The difference was statistically significant (P < 0.05). Operative time were statistically significantly shorter in the observation group [99.5 (84.0–120.0) min and 109.0 (83.8–143.0) min, P < 0.05]. Lengths of postoperative hospital stays were 4 (4–7) and 5 (4–7) days in the observation and control group, which was significantly shorter in the observation group (P < 0.05). There were no significant differences in PAS scores, blood transfusion volume, neonatal weight, fever, hematoma, thrombus, bladder rupture and ICU transfer rates between the two groups. All patients, except one in control group, had preserved uterus. There were no statistically significant differences in short-term and long-term complications between two groups. Conclusion In summary, when combined with tourniquet and/or prophylactic abdominal aorta balloon occlusion, modified Triple-P procedure may be effective in reducing intraoperative blood loss and hysterectomy in patients with placenta increta/percreta. It is a safe and effective surgical alternative to peripartum hysterectomy. However, the complications associated with interventional radiology service should be evaluated furthermore.
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Affiliation(s)
- Huidan Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Xianlan Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Chen Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Ya Tao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China
| | - Ruixia Guo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Fu M, Bu H, Fang Y, Wang C, Zhang L, Zhang Y, Sun X, Li M, Jin C, Xu Y, Chen L. Parallel Loop Binding Compression Suture, a Modified Procedure for Pernicious Placenta Previa Complicated With Placenta Increta. Front Surg 2021; 8:786497. [PMID: 34912843 PMCID: PMC8666452 DOI: 10.3389/fsurg.2021.786497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/30/2021] [Accepted: 11/08/2021] [Indexed: 11/20/2022] Open
Abstract
Objective: To evaluate the efficacy and safety of parallel loop binding compression suture of the lower uterus during cesarean section in pernicious placenta previa complicated with placenta increta. Methods: This retrospective study was performed in patients with pernicious placenta previa complicated with placenta increta or percreta between November 2014 and December 2020 at the Qilu Hospital of Shandong University. Patients underwent parallel loop binding compression suture surgery were defined as study group, and patients underwent traditional surgery with figure-of-eight sutures as the main hemostatic method were defined as control group. Postpartum hemorrhage was evaluated as the primary outcome. The secondary outcomes included age, gestational weeks, operative time, fetal childbirth time, prevention of hysterectomy, blood transfusion, duration of postoperative catheterization, duration of antibiotic treatment, and postoperative hospitalization (days). Additionally, neonatal outcomes were evaluated. Results: A total of 124 patients were enrolled in the study, including 38 patients receiving parallel loop binding compression suture surgery in the study group, and 86 patients in the control group. With parallel loop binding compression suture, the average operation time was significantly reduced (109.0 ± 33.5 vs. 134.4 ± 54.2 min, p = 0.00), and the volume of blood lost were also decreased (2152.6 ± 1169.4 vs. 2960.5 ± 1963.6 ml, p = 0.02), which correspondingly reduced RBC transfusion (7.2 ± 3.5 vs. 10.3 ± 8.7 units, p = 0.03) and FFP transfusion (552.6 ± 350.3 vs. 968.0 ± 799.8 ml, p = 0.00). The fetal childbirth time was extended (14.1 ± 5.6 vs. 11.0 ± 8.0 min, p = 0.03), however, there was no increase in NICU admission rates (36.9 vs. 34.9%, p = 0.83). Except for one premature infant (32 weeks) death in the control group, all infants at our hospital were safely discharged after treatment. Conclusion: Parallel loop binding compression suture is an effective, swift, practical, and safe method to reduce postpartum bleeding in women with pernicious placenta previa, complicated with placenta increta. Besides, it has no adverse effects on newborns.
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Affiliation(s)
- Mengdi Fu
- Department of Gynecology and Obstetrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hualei Bu
- Department of Gynecology and Obstetrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yan Fang
- Department of Gynecology and Obstetrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chunling Wang
- Department of Anesthesia, Qilu Hospital, Shandong University, Jinan, China
| | - Li Zhang
- Department of Anesthesia, Qilu Hospital, Shandong University, Jinan, China
| | - Yang Zhang
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiao Sun
- Department of Ultrasound, Qilu Hospital, Shandong University, Jinan, China
| | - Mingbao Li
- Department of Gynecology and Obstetrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chengjuan Jin
- Department of Obstetrics and Gynecology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yintao Xu
- Department of Gynecology and Obstetrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lijun Chen
- Department of Gynecology and Obstetrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Wei CN, Drzymalski D, Cao YF, Ping ZP, Wu H, Chen XZ. The Intraoperative Median Effective Dose of Oxytocin for Preventing Uterine Atony in Parturients with a Prior History of Caesarean Delivery. Clin Drug Investig 2021; 41:1047-53. [PMID: 34655431 DOI: 10.1007/s40261-021-01090-x] [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] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE While oxytocin is commonly used for the prevention of uterine atony, its pharmacology may be affected by a prior history of caesarean delivery. The objective of this study was to determine the 50% effective dose (ED50) of bolus oxytocin after caesarean delivery in parturients with and without prior caesarean delivery. METHODS This was a parallel-group, double-blind, dose-response study using Dixon's up-and-down sequential allocation method to estimate the ED50 of bolus-administered oxytocin in parturients having caesarean delivery under combined spinal-epidural anaesthesia (CSE). Twenty-seven parturients with a history of prior caesarean delivery (With-PCD group) and 26 parturients with no such history (Without-PCD group) were enrolled. Oxytocin was administered as an intravenous bolus at a starting dose of 0.5 units, which was then increased or decreased by 0.25 units at a time. Uterine tone was assessed by the obstetrician as either 'adequate' or 'inadequate' 3 min after delivery of the fetus. Adverse effects, administration of additional uterotonic agents, and estimated blood loss were recorded. RESULTS The ED50 of oxytocin was greater in the With-PCD group than in the Without-PCD group (0.95 units [95% CI 0.82-1.08] vs. 0.55 units [95% CI 0.38-0.73], P < 0.001). The overall incidence of adverse effects was higher in the With-PCD group than in the Without-PCD group (33.3% vs. 7.7%, P = 0.02). CONCLUSION The initial bolus dose of oxytocin needed to prevent uterine atony was higher in parturients with prior caesarean delivery than in parturients without prior caesarean delivery. Uterine scarring may contribute to the increased oxytocin requirements of the former group. TRIAL REGISTRATION NUMBER ChiCTR1900023474; investigator: Wei CN; date of registration: 30 May 2019.
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Li GT, Lu Y, Xu HM. Response to "Letter to "Removable retropubic uterine compression suture for controlling postpartum hemorrhage": The latest, the best?". J Obstet Gynaecol Res 2021; 47:4129-4130. [PMID: 34382272 DOI: 10.1111/jog.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 07/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Guang-Tai Li
- Department of Obstetrics and Gynecology, Hebei Yanda Hospital, Affiliated to Hebei Medical University, Yanda International Health City, Sipulan Road, Yanjiao Economic and Technological Development Zone, Beijing Eastern suburb, Sanhe, China.,Department of Obstetrics and Gynecology, Pharmacy, China Meitan General Hospital (Emergency General Hospital), Beijing, China
| | - You Lu
- Department of Obstetrics and Gynecology, Pharmacy, China Meitan General Hospital (Emergency General Hospital), Beijing, China
| | - Hong-Mei Xu
- Department of Obstetrics and Gynecology, Beijing Fengtai Hospital, Affiliated to Capital Medical University, Beijing, China
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Gan Y, Chen Z, Shi Q. The efficacy between cervical-lifting suture and lower B-Lynch suture in placenta previa: a retrospective cohort-study. Arch Gynecol Obstet 2020; 302:365-376. [PMID: 32500216 DOI: 10.1007/s00404-020-05625-z] [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: 07/12/2019] [Accepted: 05/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE This study is performed to evaluate and compare the efficacy of cervical-lifting suture and lower B-Lynch suture in different severity of placenta previa associated with lower uterine segment bleeding. METHODS We evaluated the effectiveness of cervical-lifting suture (n = 51) and lower B-Lynch suture (n = 137) in stopping the bleeding from lower uterine segment. Additionally, we used different statistical methods, including overall analysis, subgroup analysis and approximate randomization analysis, to evaluate the efficacy of the two assessments. RESULTS The medical records of these 188 participants were extracted and all of the patients were followed up for six weeks. The majority of patients were multipara and complicated with previous cesarean delivery and abnormal adherent placenta. The median intraoperative blood loss and the median amount of red blood cell transfusion were lower in the cervical-lifting suture group in comparison to the lower B-Lynch suture group. CONCLUSION Our study provides evidence that cervical-lifting suture has less intraoperative blood loss and red blood cell transfusion for controlling lower uterine segment bleeding in placenta previa.
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Affiliation(s)
- Yanqiong Gan
- Department of Obstetrics and Gynecology, The Affiliated Hospital of North Sichuan Medical College, No.63, Wenhua Road, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China
| | - Zhaoxia Chen
- Department of Obstetrics and Gynecology, The Affiliated Hospital of North Sichuan Medical College, No.63, Wenhua Road, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China
| | - Qi Shi
- Department of Obstetrics and Gynecology, The Affiliated Hospital of North Sichuan Medical College, No.63, Wenhua Road, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China.
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8
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Zhao B, Lv M, Dong T, Chen Y, Xi F, Lv W, Luo Q. Transverse parallel compression suture: a new suturing method for successful treating pernicious placenta previa during cesarean section. Arch Gynecol Obstet 2020; 301:465-472. [DOI: 10.1007/s00404-020-05435-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
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Acar A, Ercan F, Pekin A, Elci Atilgan A, Sayal HB, Balci O, Gorkemli H. Conservative management of placental invasion anomalies with an intracavitary suture technique. Int J Gynaecol Obstet 2018; 143:184-190. [PMID: 29989156 DOI: 10.1002/ijgo.12593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/24/2017] [Revised: 04/25/2018] [Accepted: 07/06/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of a new surgical suture technique for uterine preservation among patients with placental invasion anomalies. METHODS The present prospective case series included women diagnosed with placental invasion anomalies undergoing cesarean deliveries who desired future fertility at the obstetrics department of a Turkish university hospital between January 10, 2013, and April 20, 2017. Patients were diagnosed with ultrasonography and Doppler ultrasonography; the type of placental invasion anomaly (placenta accreta, increta, or percreta) was confirmed intraoperatively. Surgical management involved an intracavitary suture technique after the proximal branch of the uterine artery was clamped and utero-ovarian anastomoses had been blocked. Outcomes included units of blood transfused, intraoperative and postoperative adverse events, duration of hospital admission, and hysterectomy rate. RESULTS There were 62 patients included. The mean operative blood loss was 1350 ± 750 mL (range 600-5000 mL). Blood transfusion required a mean of four units (range 2-15). Bleeding was controlled with the intracavitary sutures in 58 (94%) patients. Three patients experienced postoperative wound infections and two patients developed endometritis that required therapy with broad-spectrum antibiotics. The mean length of hospital stay was 3.6 ± 1.6 days (range 2-11). None of the patients required reoperation after the initial surgery. CONCLUSION The novel uterus-sparing suture technique was highly effective among patients with placental invasion anomalies.
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Affiliation(s)
- Ali Acar
- Division of Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Fedi Ercan
- Division of Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Aybike Pekin
- Division of Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Adeviye Elci Atilgan
- Division of Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hasan Berkan Sayal
- Department of Obstetrics and Gynecology, Malatya State Hospital, Malatya, Turkey
| | - Osman Balci
- Division of Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hüseyin Gorkemli
- Division of Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Li GT, Li XF, Zhang YH, Si Y, Li GR, Xu HM. Ring compression suture for controlling post-partum hemorrhage during cesarean section. J Obstet Gynaecol Res 2018; 44:1424-1430. [PMID: 29744974 DOI: 10.1111/jog.13676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 08/29/2017] [Accepted: 04/08/2018] [Indexed: 11/29/2022]
Abstract
AIM To avoid complications associated with uterine compression sutures, we devised a ring compression suture (RCS). METHODS The RCS was performed on 12 patients with post-partum hemorrhage (PPH) during cesarean section. The suture was inserted 0.5 cm below the attachment point of the uterosacral ligament into the uterine cavity and pushed downward through the cervical canal into the vagina. The other end of the stitch was threaded through the lower abdominal wall, from the inside of the abdomen cavity to the outside of the abdominal wall, emerging at the external surface of the lower abdomen 2 cm lateral to the ventral median line and 1 cm above the symphysis pubis. Then, the two ends of the suture (the end in the vagina had been pulled out in advance) were tied tightly on the pudendum. The same stitch was repeated on the contralateral side. After 48 h postoperatively, the suture was removed through the vagina under sterilization. RESULTS All 12 women with PPH who underwent RCS achieved hemostasis, and complications related to RCS were not seen. Two of them had successful pregnancies postoperatively. The remaining women had no desire for a further pregnancy. CONCLUSION The procedure can be used as an alternative to peripartum hysterectomy and also as a prophylactic application in PPH.
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Affiliation(s)
- Guang-Tai Li
- Department of Obstetrics and Gynecology, China Meitan General Hospital, Beijing, China
| | - Xiao-Fan Li
- Department of Radiation Oncology, Peking University School of Oncology, Peking University Cancer Hospital, Beijing, China
| | - Yun-He Zhang
- Department of Obstetrics and Gynecology, China Meitan General Hospital, Beijing, China
| | - Yue Si
- Department of Obstetrics and Gynecology, China Meitan General Hospital, Beijing, China.,Department of Obstetrics and Gynecology, Beijing Fengtai Hospital, Affiliated Capital Medical University, Beijing, China
| | - Guang-Rui Li
- China Academy of Chinese Medical Sciences, Wangjing Hospital, Beijing, China
| | - Hong-Mei Xu
- Department of Obstetrics and Gynecology, Beijing Fengtai Hospital, Affiliated Capital Medical University, Beijing, China
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11
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Meng Y, Wu P, Deng D, Wu J, Lin X, Beejadhursing R, Zha Y, Qiao F, Feng L, Liu H, Zeng W. Multifaceted spiral suture: A hemostatic technique in managing placenta praevia or accrete: A retrospective study. Medicine (Baltimore) 2017; 96:e9101. [PMID: 29245338 PMCID: PMC5728953 DOI: 10.1097/md.0000000000009101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients with total placenta previa and past history of cesarean delivery often experience overwhelming hemorrhage during childbirth. In order to control intraoperative and postoperative bleeding, we propose a novel multifaceted spiral suture of the lower uterine segment which directly sutures the bleeding site.To evaluate the efficacy and safety of multifaceted spiral suture, a retrospective study was conducted using data from 33 patients with total placenta praevia and caesarean history.All participants underwent multifaceted spiral suture and no patient experienced uncontrollable bleeding or underwent hysterectomy.The average blood loss of all patients involved was 1327.3 ± 1244.1 mL. Five patients reported blood loss exceeding 3000 mL (15.15%), and the highest reached to 4000 mL. No complications such as fever, pyometra, synechiae, or uterine necrosis were observed. Three cases (3/33, 9.09%) reported hematuria in the first 3 days following surgery and spontaneous resolution were observed within 3 to 7 days following insertion of indwelling catheters. No complaints were received during 6-month follow-up visits.These findings suggest that multifaceted spiral suture is a practical, feasible, and promising technique in potentially minimizing postpartum bleeding and avoiding hysterectomy for patients with placenta praevia or accrete.
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Abstract
China recently instituted a two-child policy in response to its aging population, declining workforce and demographic dividend, and the need to develop asocial economy. Additionally, women generally delay having a second child because of the overwhelming pressure in their lives. With the improvements in assisted fertility technologies in recent years, the number of elderly women attempting to bear children has increased. The quality of woman's eggs and a man's sperm declined dramatically with increasing age, leading to an increased risk of pregnancy-related complications among older women. Therefore, the types of fertility problems experienced by elderly females must be provided with considerable attention by obstetricians. This commentary article focuses on the medical problems faced by older second-child pregnant women. This work discusses their increased rates of infertility, spontaneous abortion, fetal malformation, gestational diabetes, cesarean section, placenta previa, postpartum hemorrhage, postpartum depression, and hypertensive disorders, which complicate pregnancy.
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Affiliation(s)
- Qiang Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dongrui Deng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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13
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Suzuki Y, Matsuzaki S, Mimura K, Kumasawa K, Tomimatsu T, Endo M, Kimura T. Investigation of perioperative complications associated with use of uterine compression sutures. Int J Gynaecol Obstet 2017; 139:28-33. [DOI: 10.1002/ijgo.12249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/28/2017] [Accepted: 06/26/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Yosuke Suzuki
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Osaka Japan
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Abstract
OBJECTIVE Placenta previa is associated with maternal hemorrhage, but most literature focuses on morbidity in the setting of placenta accreta. We aim to characterize maternal morbidity associated with previa and to define risk factors for hemorrhage. METHODS This is a secondary cohort analysis of the NICHD Maternal-Fetal Medicine Units Network Cesarean Section Registry. This analysis included all women undergoing primary Cesarean delivery without placenta accreta. About 496 women with previa were compared with 24,201 women without previa. Primary outcome was composite maternal hemorrhagic morbidity. Non-hemorrhagic morbidities and risk factors for hemorrhage were also evaluated. RESULTS Maternal hemorrhagic morbidity was more common in women with previa (19 versus 7%, aRR 2.6, 95% CI 1.9-3.5). Atony requiring uterotonics (aRR 3.1, 95% CI 2.0-4.9), red blood cell transfusion (aRR 3.8, 95% CI 2.5-5.7), and hysterectomy (aRR 5.1, 95% CI 1.5-17.3) were also more common with previa. For women with previa, factors associated with maternal hemorrhage were pre-delivery anemia, thrombocytopenia, diabetes, magnesium use, and general anesthesia. CONCLUSION Placenta previa is an independent risk factor for maternal hemorrhagic morbidity. Some risk factors are modifiable, but many are intrinsic to the clinical scenario.
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Affiliation(s)
- Karen J Gibbins
- a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.,b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA
| | - Brett D Einerson
- a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.,b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA
| | - Michael W Varner
- a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.,b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA
| | - Robert M Silver
- a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.,b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA
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