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Wang Y, Zhang S. Reflections on peripartum hysterectomy: A 10-year retrospective observational study in Northeast China. Int J Gynaecol Obstet 2024; 165:764-771. [PMID: 37964420 DOI: 10.1002/ijgo.15241] [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: 06/08/2023] [Revised: 08/30/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To explore the change trends in incidence and leading factors to peripartum hysterectomy (PH) at a regional tertiary medical center in northeast China. METHODS This was a retrospective observational study of all PH cases conducted at Shengjing Hospital between January 1, 2012 and December 31, 2021. Information on maternal characteristics of pregnancy and delivery, indications of PH, inventions before hysterectomy, complications, and maternal and neonatal outcomes obtained from the Shengjing Hospital Information System were analyzed. RESULTS Among a total of 157 553 deliveries, there were 127 cases of PH (overall PH incidence: 0.85/1000 deliveries); 120 patients (94.49%) underwent hysterectomy after cesarean section, and seven (5.51%) underwent vaginal delivery (P < 0.001). Abnormal placentation was the leading indication for PH (101, 79.53%), including placenta previa (PP) with placenta accreta spectrum (PAS) (93, 73.23%), PP alone (5, 3.94%), and PAS alone (3, 2.36%). Among the patients who underwent PH with abnormal placentation, 92.08% had at least one cesarean section (P < 0.001) and 20.19% had bladder injury (P = 0.044). All maternal deaths (n = 2) occurred in referral patients, and the maternal mortality rate was 1.57/100 hysterectomies. CONCLUSION Abnormal placentation was the primary indication for PH. For such patients, adequate assessment of their condition and complete communication are strongly recommended. The identification of high-risk groups for postpartum hemorrhage, timely and effective rescue, and referral are equally important for avoiding PH.
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Affiliation(s)
- Yang Wang
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuo Zhang
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Germano C, Girlando F, Carosso AR, Messina A, Parpinel G, Leo L, Attini R, Revelli A, Masturzo B. Uterine Balloon Tamponade under Ultrasound Guidance in Women with Postpartum Hemorrhage: A Retrospective Cohort Study. J Clin Med 2024; 13:2632. [PMID: 38731162 PMCID: PMC11084657 DOI: 10.3390/jcm13092632] [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: 03/09/2024] [Revised: 04/15/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Postpartum hemorrhage (PPH) represents one of the principal causes of maternal mortality and morbidity worldwide. Uterine balloon tamponade (UBT) is recommended for the treatment of postpartum hemorrhage due to uterine atony in women who do not respond to pharmacological first-line treatment. The success of UBT in bleeding control is related to the correct positioning of the device, since incorrect insertion can be associated with ineffectiveness and requires time-consuming repositioning maneuvers, with a further increase in blood loss. The use of ultrasound (US) during UBT may increase the success rate by preventing wrong positioning. This study aims to demonstrate the role of US guidance during UBT and to assess whether US guidance can ease positioning and reduce insertion times, preventing additional repositioning maneuvers, in comparison with a US check carried out after balloon insertion. Methods: This was a retrospective study including 370 women who underwent vaginal delivery, had PPH caused by uterine atony and required UBT at Sant'Anna Hospital from 2015 to 2019. The exclusion criteria were an abnormal placental site, vaginal or cervical trauma, coagulation defects, uterine anomalies, previous postpartum hemorrhage and previous caesarean section. Included subjects were divided into two groups: the US-guided group (n = 200) underwent Bakri balloon positioning under US guidance, and the non-guided group (n = 170) received a US check only after balloon insertion. The primary outcome was the success rate of the procedure, expressed as the percentage of cases with bleeding control without the need for balloon repositioning; the secondary outcomes were the length of the procedure and some parameters related to blood loss. Results: The success rate was 99% for the US-guided group vs. 86% for the non-guided group. None of the patients required hysterectomy. In the US-guided group with respect to the non-guided group, we observed a significant reduction in blood loss (1100 ± 450 vs. 1500 ± 600 mL; p < 0.001), Δhemoglobin level (1.8 ± 1.1 vs. 2.7 ± 2.0 g/dL, p < 0.001) and time required for the procedure (8 vs. 13 min, p < 0.001). Conclusions: Our data suggest that the use of US guidance for placement of UBT was associated with reduced need for balloon repositioning, lower blood loss, and faster resolution of postpartum hemorrhage.
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Affiliation(s)
- Chiara Germano
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Flavia Girlando
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Andrea Roberto Carosso
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Alessandro Messina
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Giulia Parpinel
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Livio Leo
- Department of Obstetrics and Gynecology, Beauregard Hospital, 11100 Aosta, Italy;
| | - Rossella Attini
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Alberto Revelli
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
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Overton E, D'Alton M, Goffman D. Intrauterine devices in the management of postpartum hemorrhage. Am J Obstet Gynecol 2024; 230:S1076-S1088. [PMID: 37690862 DOI: 10.1016/j.ajog.2023.08.015] [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: 05/31/2023] [Revised: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
Obstetrical hemorrhage is a relatively frequent obstetrical complication and a common cause of maternal morbidity and mortality worldwide. The majority of maternal deaths attributable to hemorrhage are preventable, thus, developing rapid and effective means of treating postpartum hemorrhage is of critical public health importance. Intrauterine devices are one option for managing refractory hemorrhage, with rapid expansion of available devices in recent years. Intrauterine packing was historically used for this purpose, with historical cohorts documenting high rates of success. Modern packing materials, including chitosan-covered gauze, have recently been explored with success rates comparable to uterine balloon tamponade in small trials. There are a variety of balloon tamponade devices, both commercial and improvised, available for use. Efficacy of 85.9% was cited in a recent meta-analysis in resolution of hemorrhage with the use of uterine balloon devices, with greatest success in the setting of atony. However, recent randomized trials have demonstrated potential harm associated with improvised balloon tamponade use In low resource settings and the World Health Organization recommends use be restricted to settings where monitoring is available and care escalation is possible. Recently, intrauterine vacuum devices have been introduced, which offer a new mechanism for achieving hemorrhage control by mechanically restoring uterine tone via vacuum suction. The Jada device, which is is FDA-cleared and commercially available in the US, found successful bleeding control in 94% of cases in an initial single-arm trial, with recent post marketing registry study described treatment success following hemorrhage in 95.8% of vaginal and 88.2% of cesarean births. Successful use of improvised vacuum devices has been described in several studies, including suction tube uterine tamponade via Levin tubing, and use of a modified Bakri balloon. Further research is needed with head-to-head comparisons of efficacy of devices and assessment of cost within the context of both device pricing and overall healthcare resource utilization.
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Affiliation(s)
- Eve Overton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY.
| | - Mary D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Dena Goffman
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
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Henrich W, Dückelmann A, Braun T, Hinkson L. Uterine packing with chitosan-covered tamponade to treat postpartum hemorrhage. Am J Obstet Gynecol 2024; 230:S1061-S1065. [PMID: 38462249 DOI: 10.1016/j.ajog.2022.11.1297] [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: 11/08/2022] [Accepted: 11/19/2022] [Indexed: 03/12/2024]
Abstract
Postpartum hemorrhage remains a major cause of maternal mortality and morbidity worldwide with higher rates found in resource-challenged countries. Conventional use of uterotonics such as oxytocin, prostaglandins, and medications to support coagulation, such as fibrinogen and tranexamic acid, are helpful but may not be sufficient to arrest life-threatening postpartum hemorrhage. Severe postpartum hemorrhage leads to an increased need for blood transfusions and the use of invasive techniques, such as intrauterine balloon tamponade, compression sutures, and arterial ligation, as advanced steps in the management cascade. In extreme cases where hemorrhage is resistant to these therapies, a hysterectomy may be necessary to avoid possible maternal death. Uterine packing with a chitosan-covered tamponade is an emerging tool in the armamentarium of the obstetrical team, especially when resources for advance surgical and other invasive options may be limited. Modified chitosan-impregnated gauze was originally described in the management of acute hemorrhage in the field of military medicine, combining the physiological antihemorrhaging effect of modified chitosan with a compression tamponade for the acute treatment of wound bleeding. The first described use in obstetrics was in 2012, showing that the chitosan-covered tamponade is an effective intervention to arrest ongoing therapy-resistant postpartum hemorrhage. Further studies showed a reduction in hysterectomies and blood transfusions. The method is, however, underreported and is not yet an established method used worldwide. To demonstrate the step-by-step application of the intrauterine chitosan-covered tamponade in the management of therapy-resistant postpartum hemorrhage, we have produced a teaching video to illustrate the important steps and techniques to optimize the effectiveness and safety of this novel intervention.
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Affiliation(s)
- Wolfgang Henrich
- Department of Obstetrics, Charité University Hospital, Berlin, Germany
| | - Anna Dückelmann
- Department of Obstetrics, Charité University Hospital, Berlin, Germany
| | - Thorsten Braun
- Department of Obstetrics, Charité University Hospital, Berlin, Germany
| | - Larry Hinkson
- Department of Obstetrics, Charité University Hospital, Berlin, Germany.
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Okaforcha EI, Eleje GU, Ikechebelu JI, Ezeama CO, Igbodike EP, Ugwu EO, Okpala BC, Mbachu II, Umeononihu OS, Ogabido CA, Onwusulu DN, Oguejiofor CB, Okafor CC, Olisa CL, Ikwuka DC, Ofor IJ, Okafor CG. Intravenous versus intramuscular oxytocin injection for preventing uterine atonic primary postpartum haemorrhage in third stage of labour: A double-blind randomised controlled trial. SAGE Open Med 2024; 12:20503121241230484. [PMID: 38406581 PMCID: PMC10894536 DOI: 10.1177/20503121241230484] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/18/2024] [Indexed: 02/27/2024] Open
Abstract
Objectives To compare the efficacy and safety of intravenous and intramuscular oxytocin in preventing atonic primary postpartum haemorrhage in the third stage of labour. Methods A double-blind randomised clinical study on consenting women without risk factors for primary postpartum haemorrhage in labour at term. Two hundred and thirty-two women were randomly allotted into intravenous (n = 115) and intramuscular (n = 117) oxytocin groups in the active management of the third stage of labour. All participants received 10 IU of oxytocin, either IV or IM, and 1 ml of water for injection as a placebo via a route alternate to that of administration of oxytocin within 1 min of the baby's delivery. The primary outcome measures were mean postpartum blood loss and haematocrit change. Trial Registration No.: PACTR201902721929705. Results The baseline socio-demographic and clinical characteristics were similar between the two groups (p > 0.05). There was no statistically significant difference between the two groups with regards to the mean postpartum blood loss (254.17 ± 34.85 ml versus 249.4 ± 39.88 ml; p = 0.210), haematocrit change (2.4 (0.8%) versus 2.1 (0.6%); p = 0.412) or adverse effects (p > 0.05). However, the use of additional uterotonics was significantly higher in the intravenous group (25 (21.73%) versus 17 (14.53%); p = 0.032). Conclusion Although oxytocin in both study groups showed similar efficacy in terms of preventing atonic primary postpartum haemorrhage, participants who received intravenous oxytocin were more likely to require additional uterotonics to reduce their likelihood of having an atonic primary postpartum haemorrhage. However, both routes have similar side effect profiles.
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Affiliation(s)
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Joseph Ifeanyichukwu Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Chukwuemeka Okwudili Ezeama
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Emmanuel Onyebuchi Ugwu
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Boniface Chukwuneme Okpala
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ikechukwu Innocent Mbachu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Osita Samuel Umeononihu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Chukwudi Anthony Ogabido
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Daniel Nnaemeka Onwusulu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Charlotte Blanche Oguejiofor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Chinedu Lawrence Olisa
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - David Chibuike Ikwuka
- Department of Medical Physiology, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
| | | | - Chigozie Geoffrey Okafor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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Cai Y, Li K, Shi Q. Meta-analysis of the effect of duration of labour on postpartum haemorrhage. Ginekol Pol 2024:VM/OJS/J/90444. [PMID: 38334347 DOI: 10.5603/gpl.90444] [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: 06/08/2022] [Revised: 03/27/2023] [Accepted: 05/28/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES To evaluate the relationship between stages of labour and the risk of postpartum haemorrhage (PPH) and provide evidence for clinical application. MATERIAL AND METHODS Manual searches were undertaken, and computer searches of PubMed, MEDLINE, Web of Science, CNKI, Wanfang and Wipu databases with a search window from database creation to April 2022 were conducted to procure relevant studies on the relationship between labour phase and PPH. The articles included in this study were evaluated for quality, and RevMan 5.3 software was used for meta-analysis. RESULTS Meta-analysis showed that the incidence of PPH in women with weak uterine contractions was 27.5%, compared with 18.1% in women with normal contractions [relative risk (RR) = 1.60; 95% confidence interval (CI) 1.38, 1.85; p < 0.01]. There was a statistically significant difference in the incidence of PPH in pregnant women with a prolonged second stage of labour (≥ 2 h) (34.5%) compared with those whose second stage of labour was normal in duration (15.9%) (RR = 0.20; 95% CI 0.15, 0.25; p < 0.01). The incidence of PPH was 52.1% in pregnant women with a prolonged third stage of labour (≥ 15 min) compared with 20.9% in those whose third stage of labour was of normal duration (RR = 3.53; 95% CI 2.75, 4.52; p < 0.01). The difference in the incidence of a prolonged third stage of labour in pregnant women with weak contractions compared with those with normal contractions was statistically significant (72.3% vs 15.5%) (RR = 0.47; 95% CI 0.35, 0.60; p < 0.01). CONCLUSIONS Duration of labour is associated with the development of PPH, and the risk of PPH is increased in women with weak contractions or with a prolonged second or third stage of labour.
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Affiliation(s)
- Yi Cai
- Department of Obstetrics, Beijing Obstertrics and Gynecology Hospital, Capital Medical University,Beijing United Family Hospital, China
| | - Kui Li
- Department of Obstetrics, Beijing Obstertrics and Gynecology Hospital, Capital Medical University,Beijing United Family Hospital, China
| | - Qingyun Shi
- Department of Obstetrics, Beijing Obstertrics and Gynecology Hospital, Capital Medical University,Beijing United Family Hospital, China.
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Adamec A, Vargova M, Kristufkova A, Niznanska Z, Korbel M. Peripartum hysterectomy: A 9-year population-based study in Slovakia. Int J Gynaecol Obstet 2024; 164:236-241. [PMID: 37485694 DOI: 10.1002/ijgo.15012] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/09/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To assess the incidence of peripartum hysterectomy (PH) in Slovakia. Additionally, we wanted to describe reasons for the procedure, associated clinical circumstances, and complications. METHODS This was a descriptive, population-based study among women who underwent PH in Slovakia between January 2012 and December 2020. Peripartum hysterectomy was defined as surgical removal of the uterus from the peripartum period up to 42 days postpartum. Data were obtained retrospectively from the standardized questionnaires that are completed in Slovakia for any case of PH. The background population consisted of all other women who delivered during the study period. RESULTS Of the 436 136 births, there were 397 cases of PH, giving an incidence of 0.91 per 1000 births. It was higher with advanced maternal age, multiparity, multiple pregnancies, and cesarean deliveries. The main reasons for the procedure were placental pathologies and uterine atony in 52.9% and 33.0%, respectively. A total of 150 (37.8%) women required admission to an intensive care unit. The mortality rate was 1.5%. CONCLUSION The incidence of PH is relatively high in Slovakia when compared with other European countries, highlighting the need to improve prenatal diagnosis of morbidly adherent placenta and the management of peripartum hemorrhage.
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Affiliation(s)
- Adam Adamec
- 1st Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Maria Vargova
- 1st Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Alexandra Kristufkova
- 1st Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zuzana Niznanska
- 1st Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Miroslav Korbel
- 1st Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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Nieto-Calvache AJ, Barona JS, Burgos-Luna JM, Muñoz-Córdoba L, Sarria-Ortiz D, Galindo-Velasco V, Meade Triviño P, Mondragón K, Messa-Byron A. The uterine tourniquet, a simple maneuver that may facilitate surgical management of postpartum hemorrhage. Int J Gynaecol Obstet 2024; 164:345-347. [PMID: 37776026 DOI: 10.1002/ijgo.15110] [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: 07/13/2023] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 10/01/2023]
Abstract
SynopsisThe uterine tourniquet is a temporary intervention that facilitates the application of other procedures for definitive control of postpartum hemorrhage.
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Affiliation(s)
| | | | | | - Laura Muñoz-Córdoba
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
| | | | | | | | - Karen Mondragón
- Fundación Valle del Lili, Departamento de Urgencias, Cali, Colombia
| | - Adriana Messa-Byron
- Fundación Valle del Lili, Departamento de Ginecología y Obstetricia, Cali, Colombia
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Heller DS, Cramer SF, Turner BM. Abnormal Uterine Involution May Lead to Atony and Postpartum Hemorrhage: A Hypothesis, With Review of the Evidence. Pediatr Dev Pathol 2023; 26:429-436. [PMID: 37672676 DOI: 10.1177/10935266231194698] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Uterine involution has 2 major components-(1) involution of vessels; and (2) involution of myometrium. Involution of vessels was addressed by Rutherford and Hertig in 1945; however, involution of myometrium has received little attention in the modern literature. We suggest that the pathophysiology of myometrial involution may lead to uterine atony and postpartum hemorrhage. The myometrium dramatically enlarges due to gestational hyperplasia and hypertrophy of myocytes, caused by hormonal influences of the fetal adrenal cortex and the placenta. After delivery, uterine weight drops rapidly, with physiologic involution of myometrium associated with massive destruction of myometrial tissue. The resulting histopathology, supported by scientific evidence, may be termed "postpartum metropathy," and may explain the delay of postpartum menstrual periods until the completion of involution. When uterine atony causes uncontrolled hemorrhage, postpartum hysterectomy examination may be the responsibility of the perinatal pathologist.Postpartum metropathy may be initiated when delivery of the baby terminates exposure to the hormonal influence of the fetal adrenal cortex, and may be accelerated when placental delivery terminates exposure to human chorionic gonadotrophin (HCG). This hypothesis may explain why a prolonged third stage of labor, and delays in management, are risk factors for severe hemorrhage due to uterine atony.
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Affiliation(s)
- Debra S Heller
- Department of Pathology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Stewart F Cramer
- Department of Pathology, Highland Hospital and Rochester General Hospital, University of Rochester School of Medicine, Rochester, NY, USA
| | - Bradley M Turner
- Department of Pathology, Highland Hospital and Rochester General Hospital, University of Rochester School of Medicine, Rochester, NY, USA
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Tyagi A, Deep S, Salhotra R, Malhotra R, Singla A. Minimum effective dose of oxytocin bolus during the caesarean section for patients at high vs low risk of uterine atony: A non-randomized, dual-arm, dose-finding prospective trial. Indian J Anaesth 2023; 67:690-696. [PMID: 37693025 PMCID: PMC10488585 DOI: 10.4103/ija.ija_760_22] [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: 09/02/2022] [Revised: 05/28/2023] [Accepted: 06/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Aims There are scanty data for oxytocin dose in patients at high risk of uterine atony. We aimed to compare the effective dose (ED) 90 of oxytocin for adequate uterine tone during the caesarean section in patients at high-risk vs low-risk uterine atony. Methods This dose-finding study was undertaken after ethical approval in non-labouring women aged >18 years with pre-defined risk factors for uterine atony (high-risk group) vs those without such factors (low-risk group) (n = 39 each). Starting dose of oxytocin in the first patient of low-risk and high-risk groups was 1 and 3 IU, respectively. Achieving adequate uterine tone at 3 min of oxytocin bolus was designated 'success', while inadequate tone constituted 'failure'. If the response was 'failure', the dose of oxytocin was increased for the next patient by 0.5 or 0.2 IU (high- and low-risk groups, respectively). In case of a successful response, the dose for the next patient was decreased with a probability of 1/9 using the same dosing intervals or otherwise kept unchanged. Results The ED90 (95% CI) of oxytocin bolus was 4.7 (3.3-6.0) IU for the high-risk group and 2.2 (1.3-3.2) IU for the low-risk group (P = 0.044). Oxytocin-associated tachycardia (P = 0.247) and hypotension (P = 0.675) were clinically greater for the high-risk vs low-risk group but statistically similar. Conclusion Non-labouring patients with high-risk factors for uterine atony require a greater dose of initial oxytocin bolus to achieve adequate uterine tone during the caesarean section compared to those without risk factors.
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Affiliation(s)
- Asha Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Sonali Deep
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Rashmi Salhotra
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Rajeev Malhotra
- Biostatistician, Delhi Cancer Registry, Dr. BRAIRCH, All India Institute of Medical Sciences, Delhi, India
| | - Anshuja Singla
- Department of Obstetrics and Gynecology, University College of Medical Sciences and GTB Hospital, Delhi, India
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Anaposala S, Kalluru PKR, Calderon Martinez E, Bhavanthi S, Gundoji CR. Postpartum Hemorrhage and Tranexamic Acid: A Literature Review. Cureus 2023; 15:e38736. [PMID: 37292548 PMCID: PMC10247241 DOI: 10.7759/cureus.38736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
This review aims to explore the postpartum hemorrhage (PPH) burden and the efficacy of prophylactic tranexamic acid (TXA) in PPH and recent indications of TXA. A comprehensive review of the literature was conducted using a combination of Medical Subject Headings keywords including "Postpartum haemorrhage," "Tranexamic acid," and "Cesarean section." PPH has been explored for epidemiology, risk factors, and pathophysiology in the first part of the article. Recent indications of TXA, obstetric indications, and the role of TXA as prophylaxis for PPH are discussed in the second part of this article. TXA has many indications apart from obstetric indications and shows a significant effect in controlling bleeding. Furthermore, TXA is more efficient in preventing PPH if administered during the final stage of labor and is a valuable option for managing obstetric bleeding.
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12
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Alves ÁLL, da Silva JB, de Oliveira Santos M, Lopes AVB, Silva RBV, Senra JC. Uterine tamponade in postpartum hemorrhage with handmade balloons: Comparison of manufacturing, infusion, and total times. Int J Gynaecol Obstet 2023. [PMID: 36728548 DOI: 10.1002/ijgo.14711] [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: 05/10/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the manufacturing, infusion, and total times of handmade balloons for uterine tamponade using the El Hennawy and Alves techniques, given the failure of initial measures and uterotonic therapy to control postpartum hemorrhage. METHODS An open clinical trial (clinical article) was conducted among 30 physicians, residents, and assistants in an Obstetrics Department. Each participant manufactured and infused one of two different balloons compared in the study, in a randomly predefined sequence. The manufacturing and infusion times were timed by the researchers and their medians were compared using the t test or Mann-Whitney U test. RESULTS The manufacturing time of the El Hennawy balloon was 72 s lower in relation to the Alves balloon (P < 0.010). Regarding the infusion time, the Alves balloon was filled faster than the El Hennawy balloon (P < 0.010). The total time (manufacturing and infusion) of Alves balloon was also lower than the El Hennawy device (P < 0.010). CONCLUSIONS Although the El Hennawy balloon was manufactured more quickly, the total time of manufacturing and infusing the Alves balloon was much faster, which makes it the most suitable device to be used in critical situations of postpartum hemorrhage.
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Affiliation(s)
- Álvaro Luiz Lage Alves
- Department of Obstetrics and Gynecology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jane Braga da Silva
- Department of Obstetrics and Gynecology, Sofia Feldman Hospital, Belo Horizonte, Brazil
| | | | - Andrezza Vilaça Belo Lopes
- Department of Obstetrics and Gynecology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Janaína Campos Senra
- Department of Obstetrics and Gynecology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
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13
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Zouaghi C, Chaouch MA, Sanchez S, Zouaghi S. Hysteroscopy after conservative surgical treatment of severe postpartum hemorrhage due to uterine atony: A systematic literature review. Int J Gynaecol Obstet 2023. [PMID: 36710527 DOI: 10.1002/ijgo.14704] [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: 10/11/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the prevalence of intrauterine anomalies, primarily intrauterine adhesions (IUAd), after conservative surgical treatment of severe postpartum hemorrhage with uterine atony (SPPH-UA) and determine patient eligibility for hysteroscopy. METHODS PubMed and the Cochrane Library were searched by combining keywords "postpartum hemorrhage", "uterine atony", and "hysteroscopy" to perform a literature review. Articles in French and English with more than five cases of hysteroscopy following SPPH-UA were selected. All cases that had hysteroscopy after conservative surgical treatment of SPPH-UA were collected. A blinded statistical analysis revealed IUAd risk factors. RESULTS In all, 83% of patients agreed to hysteroscopy and 38% of 71 cases had an IUAd. Age was not a risk factor (P = 0.950). Other factors included multiparity (odds ratio [OR] 1.93, P = 0.039), cesarean delivery (OR 3.58, P = 0.584) and postpartum infection (OR 3.33, P = 0.04). Risk was at 57% after uterine padding with multiple transfixing square stitches (Cho-technique) (P = 0.001), 6% after non-transfixing uterine folding brace suture (B-Lynch technique) when used alone, 29% after uterine artery embolization and after internal iliac artery ligation (OR 0.98, P = 0.645); uterine vascular ligation (OR 0.69, P = 0.253) and more than two procedures (OR 0.69, P = 2.53). Disparity between authors was observed (P = 0.015) and concerned only the surgical techniques used. CONCLUSION A classification is proposed for deciding post-SPPH hysteroscopy. Further studies are required to determine appropriateness.
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Affiliation(s)
- Chiheb Zouaghi
- Department of Gynecology and Obstetrics, Nevers Agglomeration Hospital, Nevers, France
| | - Mohamed Ali Chaouch
- Department of Visceral Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Stephane Sanchez
- Public Health and Performance Department, Champagne Sud Hospital, Troyes, France
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14
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Pache B, Balaya V, Desseauve D. Temporary cervical sling and uterine twist before B-Lynch for massive uterine bleeding after delivery. J OBSTET GYNAECOL 2022; 42:3393-3394. [PMID: 35930408 DOI: 10.1080/01443615.2022.2106827] [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] [Indexed: 01/06/2023]
Abstract
Massive uterine bleeding occurring after delivery is in most cases unpredictable and can have fatal consequences. This article presents the technique of combining the twisting of uterus on a 90° rotation on its axis and positioning a sling around the cervix, allowing to decrease incoming blood flow from uterine and ovarian arteries. The aim of this easy-to-use procedure is to enable surgeons and anaesthesiologists to respectively ensure the presence of an experienced surgeon and to stabilise the haemodynamic of the patient. It is a modus operandi of particular interest in resources' challenged environments.
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Affiliation(s)
- Basile Pache
- Department of Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,University of Lausanne (UNIL), Lausanne, Switzerland
| | - Vincent Balaya
- Department of Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,University of Lausanne (UNIL), Lausanne, Switzerland
| | - David Desseauve
- Department of Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,University of Lausanne (UNIL), Lausanne, Switzerland
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15
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Habek D, Marton I, Prka M, Luetić AT, Vitić M, Jurković AM. Transvaginally surgically treatment of early postpartum hemorrhage caused by lower uterine segment atony. J Perinat Med 2022; 50:933-938. [PMID: 35531792 DOI: 10.1515/jpm-2021-0686] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/27/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Prove the success of transvaginal hemostatic procedures in treatment of the early postpartum hemorrhage caused by lower uterine segment atony. METHODS We have conducted a retrospective, clinical study during a 10-year period (2010-2019) in our institution that is tertiary perinatal university center. RESULTS This particular study enrolled total number of 29,543 deliveries with 215 cases of early postpartum hemorrhage (0.72%). Lower uterine segment atony was diagnosed in 44 cases (29.93%) in all uterine atony cases of early postpartum hemorrhage. Hemostatic ligation procedures according to authors: Losickaja in two cases, Hebisch-Huch in 13 cases, Habek in seven cases, Hebisch-Huch + Losickaja in 10 cases. According to our results, hemostatic ligation procedures alone (32 cases; 72.72%) or combined with gauze or ballon tamponade (five cases, 11.36%), have shown to be highly effective in 37 cases (84.09%). CONCLUSIONS Lower uterine segment atony should definitely be identified and understood as a clinical entity. Transvaginal hemostatic approach for surgical treatment of lower uterine segment atony is accessible, minimally invasive, feasible, successful and lifesaving. All of the above-mentioned methods are of great importance in the prevention and treatment of obstetric shock, multiorgan failure, postpartum hysterectomy and finally vital for fertility preservation.
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Affiliation(s)
- Dubravko Habek
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
| | - Ingrid Marton
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
| | - Matija Prka
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
| | - Ana Tikvica Luetić
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
| | - Mirjam Vitić
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
| | - Ana Marija Jurković
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
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16
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Puente-Luján MJ, Andrés-Orós MP, Álvarez-Sarrado L, Agustín-Oliva A, González-Ballano I, Rodríguez-Solanilla B, Castán-Mateo S. Bakri Balloon: an easy, useful and effective option for the treatment of postpartum haemorrhage. J OBSTET GYNAECOL 2022; 42:1788-1792. [PMID: 35291903 DOI: 10.1080/01443615.2022.2039903] [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] [Indexed: 10/18/2022]
Abstract
We report our postpartum haemorrhage protocol focussing on the use of Bakri Balloon, describing its placement and affixing method, effectiveness rates, risk factors that might contribute to Bakri Balloon's failure and complications associated. We designed a retrospective study including 147 cases where a Bakri Balloon was necessary to control the postpartum uterine bleeding to assess the efficacy and to determine which clinical, obstetric or delivery variables could be associated with successful treatment. Failed treatment was defined when surgery or any other technique was needed after a Bakri Balloon placement in order to control uterine bleeding. For statistical analysis, we developed a descriptive analysis and a univariate logistic regression study.IMPACT STATEMENTWhat is already known on this subject? Postpartum haemorrhage is one of the most severe situations in the immediate postpartum period entailing a major cause of maternal morbimortality if an accurate and quick intervention is not carried out.What do the results of this study add? The use of Bakri Balloon was effective in 94.6% of patients. No statistically significant differences were found in the success rates according to obstetric or delivery characteristics. No major complications occurred due to the placement of a Bakri Balloon. In the failure group, blood loss was significantly higher and all required blood products transfusion.What are the implications of these findings for clinical practice and/or further research? Bakri Balloon is an easy-to-use device that provides an effective therapeutic alternative to more aggressive techniques in postpartum haemorrhages when medical treatment fails. Obstetrics or delivery characteristics should not entail a contraindication in its use. A continuous training system based on an agreed protocol is recommended in order to guarantee the best care possible.
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Affiliation(s)
| | | | | | - Andrea Agustín-Oliva
- Department of Obstetrics, Miguel Servet Maternal University Hospital, Zaragoza, Spain
| | | | | | - Sergio Castán-Mateo
- Department of Obstetrics, Miguel Servet Maternal University Hospital, Zaragoza, Spain
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17
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Li WJ, Chen KH, Huang LW, Tsai YL, Seow KM. Low Maternal Serum 25-Hydroxyvitamin D Concentration Is Associated With Postpartum Hemorrhage: A Retrospective Observational Study. Front Endocrinol (Lausanne) 2022; 13:816480. [PMID: 35370939 PMCID: PMC8968120 DOI: 10.3389/fendo.2022.816480] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/22/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The primary aim of this study is to investigate the relationship between vitamin D serum level and the incidence of postpartum hemorrhage (PPH). The secondary objective is to determine the relative risk of low vitamin D associated with PPH. METHODS This was a retrospective observational study. A total of 600 women who had delivered their babies in a single tertiary teaching hospital were enrolled. Serum blood test for 25(OH)D was performed at 35 + 0 to 36 + 6 weeks of pregnancy to measure vitamin D. A 25(OH)D level < 20 ng/mL was defined as vitamin D deficient, and a level 21-29 ng/mL as insufficient. RESULTS Vitamin D levels were deficient in 145 (24.1%) and insufficient in 254 (42.3%) of the women tested. Women with deficient and insufficient vitamin D levels were significantly younger than those with sufficient vitamin D levels (p < 0.001). The overall rates of PPH in the deficient and insufficient groups were 6.9% (10/145) and 6.7% (17/254), respectively, and were significantly higher than the rate of the normal vitamin D group (1.5%, p = 0.009). Women with sufficient vitamin D levels had significantly higher hemoglobin levels than those with low vitamin D levels. Higher vitamin D levels were associated with a significantly low risk of PPH (AOR: 0.93, CI: 0.89-0.98, p = 0.006). CONCLUSION Our results suggest that a low vitamin D level is a risk factor for PPH. Low vitamin D also related to high risk of low hemoglobin before delivery. Thus, antepartum care should include vitamin D supplements for all women if possible.
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Affiliation(s)
- Wei-Jiun Li
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Kuo-Hu Chen
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan
- School of Medicine, Buddhist Tzu-Chi University, Hualien, Taiwan
| | - Lee-Wen Huang
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Yieh-Loong Tsai
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Kok-Min Seow,
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18
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Bekkenes M, Jørgensen MM, Flem Jacobsen A, Wang Fagerland M, Rakstad-Larsen H, Solberg OG, Aaberge L, Klingenberg O, Steinsvik T, Rosseland LA. A study protocol for the cardiac effects of a single dose of either oxytocin 2.5 IU or carbetocin 100 µg after caesarean delivery: a prospective randomized controlled multi-centre trial in Norway. F1000Res 2021; 10:973. [PMID: 34745566 DOI: 10.12688/f1000research.73112.1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Both oxytocin and carbetocin are used to prevent uterine atony and post-partum haemorrhage after caesarean delivery in many countries, including Norway. Oxytocin causes dose-dependent ST-depression, troponin release, prolongation of QT-time and arrythmia, but little is known about myocardial effects of carbetocin. We have previously demonstrated comparable vasodilatory effects of oxytocin and carbetocin and are now undertaking a Phase 4 trial to investigate whether carbetocin causes similar changes to myocardial markers compared with oxytocin. Methods: Our randomized controlled trial will be conducted at three obstetrics units at Oslo University Hospital and Akershus University Hospital, Norway. Planned enrolment will be of 240 healthy, singleton pregnant women aged 18 to 50 years undergoing planned caesarean delivery. Based on pilot study data, each participant will receive a one-minute intravenous injection of either oxytocin 2.5 IU or carbetocin 100 µg during caesarean delivery. The prespecified primary outcome is the change from baseline in high-sensitive troponin I plasma concentrations at 6-10 hours after study drug administration. Secondary outcomes include uterine tone grade at 2.5 and five minutes after study drug administration, adverse events for up to 48 hours after study drug administration, estimated blood loss within eight hours of delivery, need for rescue treatment and direct/indirect costs. Enrolment and primary analysis are expected to be completed by the end of 2021. Discussion: Women undergoing caesarean delivery should be assessed for cardiovascular risk particularly as women with an obstetric history of pregnancy induced hypertension, gestational diabetes mellitus, preterm birth, placental abruption, and stillbirth are at increased risk of future cardiovascular disease. Any additional ischaemic myocardial risk from uterotonic agents will need to be balanced with the benefit of reducing the risk of postpartum haemorrhage. Any potential cardiotoxicity difference between oxytocin and carbetocin will help inform treatment decisions for pregnant women. Registration: Clinicaltrials.gov NCT03899961 (02/04/2019).
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Affiliation(s)
- Maria Bekkenes
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Anne Flem Jacobsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | | | - Ole Geir Solberg
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Olav Klingenberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Trude Steinsvik
- Department of Laboratory Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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19
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Ramly F, Mohd Kasim N. Alternative suture tightening technique for achieving adequate suture tension during B-Lynch compression suture. Int J Gynaecol Obstet 2021; 156:577-580. [PMID: 34652812 DOI: 10.1002/ijgo.13981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Fathi Ramly
- Obstetrics & Gynaecology Department, Faculty of Medicine, MARA University of Technology (UiTM) Sungai Buloh, Sungai Buloh, Malaysia
| | - Norhana Mohd Kasim
- Obstetrics & Gynaecology Department, Hospital Sungai Buloh, Sungai Buloh, Malaysia
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20
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Ochiai D, Nakatsuka S, Abe Y, Ikenoue S, Kasuga Y, Inoue M, Jinzaki M, Tanaka M. The Efficacy of Transarterial Embolization for Postpartum Hemorrhage Complicated with Disseminated Intravascular Coagulation: A Single-Center Experience. J Clin Med 2021; 10:4082. [PMID: 34575193 DOI: 10.3390/jcm10184082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
Indications for the use of transarterial embolization (TAE) for postpartum hemorrhage (PPH) have been established. However, the efficacy of TAE for PPH complicated by disseminated intravascular coagulation (DIC) remains controversial. In this study, we investigated the efficacy of TAE for PPH complicated by DIC. A database review was conducted to identify patients who were treated with TAE for PPH at our hospital. TAE was performed in 41 patients during the study period. Effective hemostasis was achieved in all cases, but additional procedures, such as re-embolization or hysterectomy, were required in five patients (12.2%). The typical causes of PPH included uterine atony (18 cases), placenta previa (15 cases), amniotic fluid embolism (DIC-type) (11 cases), and placenta accreta spectrum (10 cases). The mean blood loss was 3836 mL. The mean obstetrical DIC and the International Society on Thrombosis and Hemostasis DIC scores were 7.9 and 2.6, respectively. The efficacy of hemostasis was comparable between patients with and without DIC. However, the complete success rate of TAE was lower in patients with DIC as the condition worsened than that in non-DIC patients. Overall, TAE is effective as a minimally invasive treatment for PPH complicated by DIC.
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21
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Phung LC, Farrington EK, Connolly M, Wilson AN, Carvalho B, Homer CSE, Vogel JP. Intravenous oxytocin dosing regimens for postpartum hemorrhage prevention following cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 225:250.e1-250.e38. [PMID: 33957113 DOI: 10.1016/j.ajog.2021.04.258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/23/2021] [Revised: 04/14/2021] [Accepted: 04/30/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the available evidence on intravenous oxytocin dosing regimens for the prevention of postpartum hemorrhage following cesarean delivery. DATA SOURCES We searched Ovid MEDLINE, Embase, Global Index Medicus, Cumulative Index of Nursing and Allied Health Literature, Cochrane Controlled Register of Trials, ClinicalTrials.gov, and the International Clinical Trials Registry Platform for eligible studies published until February 2020. STUDY ELIGIBILITY CRITERIA We included any randomized or nonrandomized study published in peer-reviewed journals that compared at least 2 different dosing regimens of intravenous oxytocin for postpartum hemorrhage prevention in women undergoing cesarean delivery. METHODS Two authors independently assessed the eligibility of studies, extracted the data, and assessed the risk of bias. The primary outcome was incidence of postpartum hemorrhage ≥1000 mL. Other review outcomes included use of additional uterotonics, blood loss, and adverse maternal events. Data were analyzed according to the type of intravenous administration (bolus only, infusion only, or bolus plus infusion) and total oxytocin dose. A meta-analysis was performed on randomized trials and the results were reported as risk ratios or mean differences with 95% confidence intervals. The Grading of Recommendations, Assessment, Development, and Evaluations scale was used to rate the certainty of evidence. Findings from dose-finding trials and nonrandomized studies were reported narratively. RESULTS A total of 35 studies (7333 women) met our inclusion criteria and included 30 randomized trials and 5 nonrandomized studies. There were limited data available from the trials for most outcomes, and the results were not conclusive. Compared with bolus plus infusion regimens, bolus only regimens probably result in slightly higher mean blood loss (mean difference, 52 mL; 95% confidence interval, 0.4-104 mL; moderate certainty). Among the bolus plus infusion regimens, initial bolus doses <5 IU may reduce nausea (risk ratio, 0.26; 95% confidence interval, 0.11-0.63; low certainty) when compared with doses of 5-9 IU. Total oxytocin doses of 5-9 IU vs total doses of 10-19 IU may increase the use of additional uterotonics (risk ratio, 13.00; 95% confidence interval, 1.75-96.37; low certainty). Effects on other outcomes were generally inconclusive. CONCLUSION There are limited data available for comparisons of IV oxytocin regimens for postpartum hemorrhage prevention following cesarean delivery. Bolus plus infusion regimens may lead to minor reductions in mean blood loss and initial bolus doses of <5 IU may minimize nausea. Bolus only regimens of 10 IU vs bolus only regimens of 5 IU may decrease the need for additional uterotonics, however, further comparative trials are required to understand the effects on other key outcomes, particularly hypotension.
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Affiliation(s)
- Laura C Phung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
| | - Elise K Farrington
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Mairead Connolly
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Population and Global Health, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Population and Global Health, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Australia
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22
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Yıldırım MA, Kavak SB, Kurkut B, Sanli C, Batmaz I, Bulu G. Comparison of a novel isthmic circumferential suture and Bakri balloon technique for the treatment of uterine atony during cesarean section. J Matern Fetal Neonatal Med 2021; 35:7737-7743. [PMID: 34362277 DOI: 10.1080/14767058.2021.1961724] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postpartum bleeding is a life-threatening obstetric complication. The most common cause is uterine atony. There is no method that can treat PPH with 100% effectiveness and therefore, efforts for the development of more effective conservative treatment methods continue. The aim of the study is to compare the effectiveness of the isthmic circumferential suture technique and the Bakri balloon tamponade in the treatment of postpartum bleeding due to uterine atony during cesarean operation. METHODS This study was conducted by retrospectively evaluating the cases who developed uterine atony during cesarean section. Group 1 (n = 15) consisted of the patients who had undergone the isthmic circumferential suture technique, and Group 2 (n = 15) comprised patients who had undergone the Bakri balloon tamponade. The two groups were compared with regard to obstetric characteristics, operative time, preoperative and postoperative features, and neonatal outcomes. RESULTS The groups were similar with regard to age, obstetric characteristics, preoperative complete blood count, neonatal outcomes and there was no statistically significant difference between groups. The operative time was significantly shorter in Group 1 (61.86 ± 6.7 vs. 69.53 ± 3.2 min; p < .05). The amount of intraoperative bleeding was lower in Group 1, although there was no statistically significant difference (1793.66 ± 323.96 versus 1886.33 ± 343.23 ml; p > .05). The postoperative blood loss was significantly less in Group 1 compared to Group 2 (101.37 ± 64.6 versus 169.32 ± 50.0 ml; p < .05). The postoperative 24-hour Htc values were significantly higher in Group 1 (28.83 ± 2.1 versus 27.08 ± 2.1 g/dl; p < .05). CONCLUSION Both methods are effective in the uterine atony during cesarean section. However, due to the shorter operative time and less pre-operative blood loss, the isthmic circumferential suture technique may be a better alternative.
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Affiliation(s)
- Mem Arjen Yıldırım
- Department of Obstetrics and Gynecology, Private Cihanpol Hospital, Kızıltepe, Turkey
| | - Salih Burcin Kavak
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Bülent Kurkut
- Department of Obstetrics and Gynecology, Private Cihanpol Hospital, Kızıltepe, Turkey
| | - Cengiz Sanli
- Department of Obstetrics and Gynecology, Fethi Sekin City Hospital, Elazig, Turkey
| | - Ibrahim Batmaz
- Department of Obstetrics and Gynecology, Hani State Hospital, Diyarbakir, Turkey
| | - Gulay Bulu
- Department of Obstetrics and Gynecology, Kovancılar State Hospital, Elazig, Turkey
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23
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Pingray V, Widmer M, Ciapponi A, Hofmeyr GJ, Deneux C, Gülmezoglu M, Bloemenkamp K, Oladapo OT, Comandé D, Bardach A, Vázquez P, Cormick G, Althabe F. Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review. BJOG 2021; 128:1732-1743. [PMID: 34165867 PMCID: PMC9292664 DOI: 10.1111/1471-0528.16819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Accepted: 04/16/2021] [Indexed: 12/01/2022]
Abstract
Objectives To evaluate uterine tamponade devices’ effectiveness for atonic refractory postpartum haemorrhage (PPH) after vaginal birth and the effect of including them in institutional protocols. Search strategy PubMed, EMBASE, CINAHL, LILACS, POPLINE, from inception to January 2021. Study selection Randomised and non‐randomised comparative studies. Outcomes Composite outcome including surgical interventions (artery ligations, compressive sutures or hysterectomy) or maternal death, and hysterectomy. Results All included studies were at high risk of bias. The certainty of the evidence was rated as very low to low. One randomised study measured the effect of the condom‐catheter balloon compared with standard care and found unclear results for the composite outcome (relative risk [RR] 2.33, 95% CI 0.76–7.14) and hysterectomy (RR 4.14, 95% CI 0.48–35.93). Three comparative studies assessed the effect of including uterine balloon tamponade in institutional protocols. A stepped wedge cluster randomised controlled trial suggested an increase in the composite outcome (RR 4.08, 95% CI 1.07–15.58) and unclear results for hysterectomy (RR 4.38, 95% CI 0.47–41.09) with the use of the condom‐catheter or surgical glove balloon. One non‐randomised study showed unclear effects on the composite outcome (RR 0.33, 95% CI 0.11–1.03) and hysterectomy (RR 0.49, 95% CI 0.04–5.38) after the inclusion of the Bakri balloon. The second non‐randomised study found unclear effects on the composite outcome (RR 0.95, 95% CI 0.32–2.81) and hysterectomy (RR 1.84, 95% CI 0.44–7.69) after the inclusion of Ebb or Bakri balloon. Conclusions The effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting. Tweetable abstract Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery. Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery.
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Affiliation(s)
- V Pingray
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - M Widmer
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - A Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - G J Hofmeyr
- University of Botswana, Gaborone, Botswana.,Effective Care Research Unit, University of the Witwatersrand/Walter Sisulu University, Mthatha, South Africa
| | - C Deneux
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, U1153 Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Paris, France
| | - M Gülmezoglu
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Concept Foundation, Geneva, Switzerland
| | - K Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - O T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - D Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - A Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - P Vázquez
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - G Cormick
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - F Althabe
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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24
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Wong JW, Wong GK. Constructing a Novel 'Uterine Sandwich' with Simultaneous Intrauterine Balloon Tamponade and Uterine Compression Sutures to Manage Postpartum Bleeding. Hawaii J Health Soc Welf 2021; 80:104-107. [PMID: 33982005 PMCID: PMC8111792] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The uterine sandwich is a relatively new surgical technique for managing postpartum hemorrhage, which is the leading cause of maternal mortality worldwide. The purpose of this case series is to describe a novel method of constructing the uterine sandwich by simultaneously combining intrauterine balloon tamponade and uterine compression sutures. Six patients with postpartum bleeding refractory to medical management were successfully treated with this novel method and avoided hysterectomy. There were no additional complications. This novel method of constructing a uterine sandwich appears to be a simple, safe, and effective technique that could be considered in cases of persistent postpartum bleeding. More research is needed to compare the efficacy of various techniques.
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Affiliation(s)
- Jennifer W.H. Wong
- Correspondence to: Jennifer W.H. Wong MD; 1319 Punahou Street Suite #824, Honolulu, HI 96826;
| | - Grace K. Wong
- Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (GKW)
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25
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Koutras A, Fasoulakis Z, Syllaios A, Garmpis N, Diakosavvas M, Pagkalos A, Ntounis T, Kontomanolis EN. Physiology and Pathology of Contractility of the Myometrium. In Vivo 2021; 35:1401-1408. [PMID: 33910817 DOI: 10.21873/invivo.12392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/02/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 11/10/2022]
Abstract
Uterine atony is a serious obstetrical complication since it is the leading cause of postpartum hemorrhage. Postpartum hemorrhage (PPH) is one of the 5 major causes of postpartum mortality; therefore, it requires immediate medical intervention, independent of whether delivery occurs normally or with a cesarean section. While in the past years most cases of postpartum hemorrhage were caused due to uterine atony following vaginal delivery, in recent years most PPH cases indicate a significant association with cesarean delivery. There are several methods used in order to avoid such a life-threatening complication, ranging from risk assessment to prevention, and finally medical intervention and management, if such an event occurs. In this scientific paper emphasis is given on the so-called "uterotonic" agents that are currently used, including oxytocin among others. It is, therefore, important to be familiar with these agents as well as understand the physiological mechanism by which they work, since they are used in everyday practice, not only for managing but also for preventing PPH. There are several potential questions that arise from the use of such "uterotonic" agents, and most specifically of oxytocin. Maybe one of the most important issues is the determination of optimal dosing of oxytocin in order to avoid PPH after a cesarean section.
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Affiliation(s)
- Antonios Koutras
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Zacharias Fasoulakis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Athanasios Syllaios
- Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece;
| | - Nikolaos Garmpis
- Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Michail Diakosavvas
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Athanasios Pagkalos
- Consultant on Department of Obstetrics and Gynecology, General Hospital of Xanthi, Xanthi, Greece
| | - Thomas Ntounis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens 'ALEXANDRA', Athens, Greece
| | - Emmanuel N Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
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26
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Sel G, Arikan II, Harma M, Harma MI. A new and feasible uterine compression suture technique in uterine atony to save mothers from postpartum hemorrhage. Niger J Clin Pract 2021; 24:335-340. [PMID: 33723106 DOI: 10.4103/njcp.njcp_140_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Postpartum hemorrhage (PPH) is one of the emergency situations of obstetrics practice that constitutes of 1 to 5% of vaginal and cesarean deliveries. Uterine atony is the number one cause of PPH and is responsible for at least 75% of PPH cases. Uterine compression sutures have been regarded as an effective method in PPH cases, as well as preserving fertility by preserving the uterus. Aims The main purpose of this study was to report on our results with a new uterine compression suture technique that was developed by us. Subjects and Methods In this study we included all women who needed uterine compression sutures because of uterine atony while cesarean section from January 2014 to December 2018. Fifteen cases with PPH with uterine atony were reported, who were treated with our uterine compression suture technique after conservative medical and uterine massage treatment failure. Results All of the cases in this study were managed successfully namely none of the patients needed a hysterectomy or reoperation because of bleeding again. One week, one month, three months later all patients were followed up. Six months later 11 patients were examined, four patients lost to follow-up, but they were reached by phone since they were outside of the city, they reported no complaints. Ultrasound examination was performed to follow up patients. Short-term follow-up revealed no complications such as pyometra, endometritis, reoperation, amenorrhea, or uterine necrosis. Conclusions We described our practice with our uterine compression suture that is easy to learn and apply. All of the cases that participated in our study showed improvement to the compression sutures, so no other surgical interventions were applied. The same suture technique was applied by only one physician. This is a feasible and easy way to stop bleeding in uterine atony and in uterine preservation, especially in rural areas when help may not be available in case of complications.
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Affiliation(s)
- G Sel
- Department of Obstetrics and Gynecology, Zonguldak Bülent Ecevit University Hospital, Zonguldak, Turkey
| | - I I Arikan
- Department of Obstetrics and Gynecology, Beykent University, İstanbul, Turkey
| | - M Harma
- Department of Obstetrics and Gynecology, Zonguldak Bülent Ecevit University Hospital, Zonguldak, Turkey
| | - M I Harma
- Department of Obstetrics and Gynecology, Zonguldak Bülent Ecevit University Hospital, Zonguldak, Turkey
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27
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Cole NM, Abushoshah I, Fields KG, Carusi DA, Robinson JN, Bateman BT, Farber MK. The interrater reliability and agreement of a 0 to 10 uterine tone score in cesarean delivery. Am J Obstet Gynecol MFM 2021; 3:100342. [PMID: 33652161 DOI: 10.1016/j.ajogmf.2021.100342] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Postpartum hemorrhage is a leading source of maternal morbidity and mortality worldwide with uterine atony identified as the underlying cause in up to 80% of cases. Several measures have been utilized to report uterine tone. The most commonly reported measure is a 0 to 10 numeric rating scale, but this scale has not been tested for reliability or agreement between different raters. OBJECTIVE The primary purpose of this study was to evaluate the interrater reliability and agreement of the 0 to 10 visual numeric rating scale of uterine tone during cesarean delivery. A secondary purpose was to obtain estimates of scale responsiveness and minimal clinically important difference. STUDY DESIGN Between August and November of 2018, obstetricians used a 0 to 10 numeric rating score to independently rate uterine tone at 3 and 10 minutes after cesarean delivery by palpation of the uterus. Of note, "0" represented "no tone" and "10" represented excellent tone. Each obstetrician independently and blinded to the other's score pointed to a numeric rating scale held by the anesthesiologist through a clear sterile drape. Intraclass correlation coefficients and Bland-Altman analysis were used to assess interrater reliability and agreement, respectively. Standardized response mean and standard error of measurement were used to obtain estimates of responsiveness and minimal clinically important difference, respectively. RESULTS A total of 82 and 84 pairs of scores were collected at 3 and 10 minutes, respectively, from pairs of 62 unique obstetricians. The mean±standard deviation difference in scores between rater 1 and rater 2 was 0.4±1.4 at 3 minutes and 0.1±1.1 at 10 minutes. Intraclass correlation coefficients for a future single rater (intraclass correlation coefficient [1, 1]) at 3 and 10 minutes were 0.67 (95% confidence interval, 0.53-0.77) and 0.61 (95% confidence interval, 0.46-0.73), and for the average between 2 future raters (intraclass correlation coefficient [1, 2]), they were 0.80 (95% confidence interval, 0.71-0.87) and 0.76 (95% confidence interval, 0.63-0.84), indicating good and excellent reliability, respectively. Bland-Altman analysis estimated 95% limit of agreement between raters of -2.4 (95% confidence interval, -3.0 to -1.9) to 3.1 (95% confidence interval, 2.6-3.7) at 3 minutes and -2.1 (95% confidence interval, -2.5 to -1.7) to 2.4 (95% confidence interval, 2.0-2.8) at 10 minutes, consistent with good interrater agreement at both time points. The standardized response mean from 3 to 10 minutes after delivery was 1.1 (n=81). Standard error of measurement was 1.0 (95% confidence interval, 0.9-1.1) at 3 minutes and 0.8 (95% confidence interval, 0.7-0.9) at 10 minutes. CONCLUSION The 0 to 10 numeric rating scale for uterine tone demonstrated good to excellent interrater reliability with 1 and 2 raters, respectively, and good interrater agreement. The scale was responsive to within-parturient change in tone, and preliminary estimates of the minimal clinically important difference were obtained. The 0 to 10 numeric rating scale for uterine tone may be a reliable, standardized tool for future research in reporting degree of uterotonic contraction during cesarean delivery.
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Affiliation(s)
- Naida M Cole
- Department of Anesthesiology, Perioperative and Pain Medicine (Drs Cole and Abushoshah, Ms Fields, and Drs Bateman and Farber).
| | - Ibrahim Abushoshah
- Department of Anesthesiology, Perioperative and Pain Medicine (Drs Cole and Abushoshah, Ms Fields, and Drs Bateman and Farber); Department of Anesthesia and Critical Care, King Abdulaziz University, King Abdulaziz University Hospital, Jeddhah, Saudi Arabia (Dr Abushoshah)
| | - Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine (Drs Cole and Abushoshah, Ms Fields, and Drs Bateman and Farber)
| | | | - Julian N Robinson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (Dr Robinson)
| | - Brian T Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine (Drs Cole and Abushoshah, Ms Fields, and Drs Bateman and Farber); Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (Dr Bateman), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michaela K Farber
- Department of Anesthesiology, Perioperative and Pain Medicine (Drs Cole and Abushoshah, Ms Fields, and Drs Bateman and Farber)
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28
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Annan JJK, Konney TO, Sam-Awortwi W, Darkwa KA. Emergency hysterectomy in a tertiary care hospital: indications, surgical outcomes and challenges: a 2-year retrospective descriptive cross-sectional study. Pan Afr Med J 2020; 37:106. [PMID: 33425139 PMCID: PMC7757309 DOI: 10.11604/pamj.2020.37.106.25393] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/27/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction emergency hysterectomy (EH) remains a life-saving procedure in cases of life-threatening obstetric hemorrhage and other gynaecological emergencies. We aim to determine the indications, surgical outcomes and challenges of EH in our tertiary centre. Methods an ethically approved retrospective descriptive cross-sectional study on all EHs performed at a tertiary hospital during the period of 1st January 2018 to 31st December 2019 was conducted. Medical records of eligible patients were retrieved, reviewed and analysed using frequencies and percentages and then summarized in tables. Results there were 146 EHs over the two year period. The age of participants ranged from 19 to 59 years, with a mean of 34.3 years (SD = 6.06). SD: standard deviation.The main indication for EH was primary postpartum haemorrhage (PPH): 73.28% (n = 110/146). The other indications were uterine perforation with necrosis: 8.9% (n = 13/146), secondary postpartum haemorrhage: 4.8% (n = 7/146), choriocarcinoma and pelvic abscess: 2.74% (n = 4/146) each and broad ligament haematoma: 2.06% (n = 3/146). There were 3.42% (n = 5/146) which were classified as 'others **': two cases of ovarian cyst torsion; one case of placental site tumour; one case of incomplete septic abortion; one case of bulky multinodular fibroid uterus with severe unremitting lower abdominal pain.The most common indication for the subgroup of hysterectomy due to PPH was uterine atony 54.20% (n = 60/110), followed by ruptured uterus20.56% (n = 23/110) and then, morbidly adherent placenta 14.95% (n = 16/110). Placenta accreta constituted 62.5% (n = 10/16) of the morbidly adherent placenta.There were 91.78% (n=134/146) total abdominal hysterectomies and 8.22% (n = 12/146) subtotalhysterectomies. About eighty percent 79.45% (n = 116/146) of the surgeries required general anaesthesia, 15.07% (n = 22/146) required regional anaesthesia whilst 5.48% (n = 8/146) were started as regional anaesthesia but were converted to general anaesthesia.There were no associated intraoperative complications in 96.60% (141/146) of the cases. The most frequent intraoperative complications included bowel injury 2.04% (3/146), bladder injury 0.68% (1/146) and maternal death 0.68% (1/146).Twoof the three bowel injuries required bowel resection and anastomosis. Most of the surgeries 89.73% (n = 131/146) were performed by skilled doctors above the level of a Specialist. Major challenges faced include delayed referral of patients to the tertiary centre for prompt management and lack of quick access to blood products. Conclusion emergency hysterectomy is performed in women who are relatively young with primary postpartum haemorrhage as the commonest indication but there are other non-obstetric indications for this emergency surgery. Though a challenging procedure, it is safe in the hands of a skilled surgical team.
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Affiliation(s)
- John Jude Kweku Annan
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas Opkoti Konney
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wilfred Sam-Awortwi
- Department of Anaesthesiology and Intensive Care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kwasi Ampem Darkwa
- Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Katayama Y, Kido S, Kai S, Nakano T, Hidaka N, Kato K. Massive atonic bleeding during cesarean delivery in a patient with chronic idiopathic intestinal pseudo-obstruction: A case report and literature review. J Obstet Gynaecol Res 2020; 46:2153-2158. [PMID: 32748506 DOI: 10.1111/jog.14363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/04/2019] [Revised: 02/11/2020] [Accepted: 06/08/2020] [Indexed: 11/27/2022]
Abstract
A 35-year-old primigravid woman with chronic idiopathic intestinal pseudo-obstruction presented to our institution. Except for an enlarged fetal bladder, her pregnancy was almost uneventful until she developed pre-eclampsia requiring emergent cesarean section at 34 weeks gestation. After delivery, intractable uterine atony developed with blood loss reaching 3500 mL within 15 min. Following a B-Lynch suture, the bleeding attenuated but uterine atony persisted; lochia persisted for 3 months post-partum. The infant was diagnosed with megacystis microcolon intestinal hypoperistalsis syndrome after birth. The mother's clinical course and previous reports suggested that atonic bleeding was associated with the pathology of chronic idiopathic intestinal pseudo-obstruction; the infant's disease was considered to be maternal-related disease. Clinicians should be vigilant in pregnant patients with chronic idiopathic intestinal pseudo-obstruction especially with these complications.
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Affiliation(s)
- Yoshihiro Katayama
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Saki Kido
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shotaro Kai
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahiro Nakano
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuhiro Hidaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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30
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Qatawneh A, Fram KM, Thikerallah F, Mhidat N, Fram FK, Fram RK, Darwish T, Abdallat T. Emergency peripartum hysterectomy at Jordan University hospital - a teaching hospital experience. Prz Menopauzalny 2020; 19:66-71. [PMID: 32802016 DOI: 10.5114/pm.2020.97840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/21/2020] [Indexed: 11/28/2022]
Abstract
Introduction Emergency peripartum hysterectomy (EPH) is a foremost operation and is perpetually implemented in the presence of life intimidating hemorrhage during or immediately after abdominal or vaginal deliveries. The aim of this study was to review cases managed at the Department of Gynecology and Obstetrics at Jordan University Hospital (JUH). Material and methods All women who underwent EPH due to any cause in the period from January 2010, to December 2017 were included in the study. Data were collected retrospectively using the patients’ files namelessly. Main measures: age, gravidity, parity, number of previous cesarean sections, previous uterine surgeries, indication for hysterectomy, complications, antepartum bleeding and the need for blood transfusion. Results In total, 74 cases of EPH were managed during the study period. The incidence of EPH ranged from 0.24 to 8.7 per 1000 deliveries. EPH was found to be more common following cesarean sections than vaginal deliveries. The prime indication was abnormal placentation, uterine atony, and uterine rupture. The risk factors included previous cesarean sections, scarred uteruses, multiparity, older age group. Maternal morbidity ranged from 26.5 to 31.5% and mortality from 0 to 12.5% with a mean of 4.8%. Conclusions EPH is the most demanding obstetric surgery performed in very tiresome circumstances of life threatening hemorrhage. The indication for EPH in recent years has changed from outdated uterine atony to abnormal placentation. Antenatal eagerness of the risk factors, engrossment of proficient obstetricians at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in tumbling morbidity and mortality.
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Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, Suarez-Rebling D, Eckardt M, Theron G, Burke TF. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 222:293.e1-293.e52. [PMID: 31917139 DOI: 10.1016/j.ajog.2019.11.1287] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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: 09/23/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the efficacy, effectiveness, and safety of uterine balloon tamponade for treating postpartum hemorrhage. STUDY DESIGN We searched electronic databases (from their inception to August 2019) and bibliographies. We included randomized controlled trials, nonrandomized studies, and case series that reported on the efficacy, effectiveness, and/or safety of uterine balloon tamponade in women with postpartum hemorrhage. The primary outcome was the success rate of uterine balloon tamponade for treating postpartum hemorrhage (number of uterine balloon tamponade success cases/total number of women treated with uterine balloon tamponade). For meta-analyses, we calculated pooled success rate for all studies, and relative risk with 95% confidence intervals for studies that included a comparative arm. RESULTS Ninety-one studies, including 4729 women, met inclusion criteria (6 randomized trials, 1 cluster randomized trial, 15 nonrandomized studies, and 69 case series). The overall pooled uterine balloon tamponade success rate was 85.9% (95% confidence interval, 83.9-87.9%). The highest success rates corresponded to uterine atony (87.1%) and placenta previa (86.8%), and the lowest to placenta accreta spectrum (66.7%) and retained products of conception (76.8%). The uterine balloon tamponade success rate was lower in cesarean deliveries (81.7%) than in vaginal deliveries (87.0%). A meta-analysis of 2 randomized trials that compared uterine balloon tamponade vs no uterine balloon tamponade in postpartum hemorrhage due to uterine atony after vaginal delivery showed no significant differences between the study groups in the risk of surgical interventions or maternal death (relative risk, 0.59; 95% confidence interval, 0.02-16.69). A meta-analysis of 2 nonrandomized before-and-after studies showed that introduction of uterine balloon tamponade in protocols for managing severe postpartum hemorrhage significantly decreased the use of arterial embolization (relative risk, 0.29; 95% confidence interval, 0.14-0.63). A nonrandomized cluster study reported that use of invasive procedures was significantly lower in the perinatal network that routinely used uterine balloon tamponade than that which did not use uterine balloon tamponade (3.0/1000 vs 5.1/1000; P < .01). A cluster randomized trial reported that the frequency of postpartum hemorrhage-related invasive procedures and/or maternal death was significantly higher after uterine balloon tamponade introduction than before uterine balloon tamponade introduction (11.6/10,000 vs 6.7/10,000; P = .04). Overall, the frequency of complications attributed to uterine balloon tamponade use was low (≤6.5%). CONCLUSION Uterine balloon tamponade has a high success rate for treating severe postpartum hemorrhage and appears to be safe. The evidence on uterine balloon tamponade efficacy and effectiveness from randomized and nonrandomized studies is conflicting, with experimental studies suggesting no beneficial effect, in contrast with observational studies. Further research is needed to determine the most effective programmatic and healthcare delivery strategies on uterine balloon tamponade introduction and use.
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Affiliation(s)
- Sebastian Suarez
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan
| | - Anderson Borovac-Pinheiro
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas (SP), Brazil
| | - Daniela Suarez-Rebling
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Melody Eckardt
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Thomas F Burke
- Division of Global Health Innovation, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Shen Y, Oda T, Tamura N, Kohmura-Kobayashi Y, Furuta-Isomura N, Yaguchi C, Uchida T, Suzuki K, Itoh H, Kanayama N. Elevated bradykinin receptor type 1 expression in postpartum acute myometritis: Possible involvement in augmented interstitial edema of the atonic gravid uterus. J Obstet Gynaecol Res 2019; 45:1553-1561. [PMID: 31179603 DOI: 10.1111/jog.14012] [Citation(s) in RCA: 4] [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: 10/19/2018] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
Abstract
AIM Uterine atony is a major cause of postpartum hemorrhage. We recently proposed a new concept for the histopathophysiology of refractory uterine atony, postpartum acute myometritis (PAM), characterized by acute inflammatory changes with massive stromal edema, increased numbers of complement C5a receptors and diffuse mast cell activation in the myometrium. We herein focused on the possible involvement of the kinin-kallikrein system in the rapid development of interstitial edema in PAM, particularly bradykinin receptor type 1 (B1R), which is up-regulated under inflammatory conditions. The present study investigated B1R expression with uterine interstitial edema in PAM. METHODS Our institution plays an important role in a Japanese amniotic fluid embolism registry project. We selected PAM cases from uterine samples delivered to us for further analyses between 2012 and 2017. Control tissues were collected during cesarean section and planned hysterectomy. B1R expression was semi-quantitatively measured by immunohistochemistry, while uterine interstitial edema was estimated by semi-quantitative measurements of the alpha smooth muscle actin-negative area using immunohistochemistry. RESULTS There were 36 and 8 cases in the PAM and control groups, respectively. The alpha smooth muscle actin-negative area was increased in the PAM group, concomitant with the significant up-regulation of B1R expression in uterine smooth muscle cells, vascular endothelial cells, and neutrophils. A positive correlation was observed between these two factors. CONCLUSION We demonstrated the up-regulated expression of B1R in the myometrium and its positive correlation with histologically estimated interstitial edema, suggesting the contribution of the kinin-kallikrein-B1R system to the development of interstitial edema in PAM cases.
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Affiliation(s)
- Yi Shen
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoaki Oda
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoaki Tamura
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukiko Kohmura-Kobayashi
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naomi Furuta-Isomura
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Chizuko Yaguchi
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiyuki Uchida
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazunao Suzuki
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroaki Itoh
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naohiro Kanayama
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Ikeda A, Kondoh E, Chigusa Y, Mogami H, Kameyama Nakao K, Kido A, Horie A, Baba T, Hamanishi J, Mandai M. Novel subtype of atonic postpartum hemorrhage: dynamic computed tomography evaluation of bleeding characteristics and the uterine cavity. J Matern Fetal Neonatal Med 2019; 33:3286-3292. [PMID: 30651015 DOI: 10.1080/14767058.2019.1571033] [Citation(s) in RCA: 6] [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] [Indexed: 10/27/2022]
Abstract
Background: Uterine atony is the leading cause of severe postpartum hemorrhage (PPH); however, the underlying cause of intractable atonic PPH unresponsive to conventional treatments (such as uterotonics and intrauterine balloon tamponade) remains unclear.Objectives: The aim of this study was to investigate whether intractable atonic PPH is associated with the type of bleeding (arterial or nonarterial) and its location, along with variations in the size and shape of the uterine cavity after delivery.Study design: This retrospective study included women who had undergone a dynamic computed tomography (CT) scan for the management of severe PPH at Kyoto University Hospital between April 2011 and March 2017. Patients' electronic medical records were reviewed, and relevant clinical information was collected. The presence of contrast extravasation (CE) on CT images in the early phase (40 s) was regarded as active arterial bleeding. Bleeding sites and size of the uterine cavity were evaluated using an xyz coordinate system. The size of the uterine cavity was compared between groups with CE into the upper and lower parts of the uterine body.Results: Of the 60 women assessed for eligibility, 30 were included in the current analysis. Contrast extravasation was detected in 19 women, with 14 showing CE in the early phase. The presence of CE in the early phase was significantly associated with the need for transarterial embolization (Fisher's exact test, p = .0017). The upper and lower parts of the uterine cavity were 97.4 ± 2.7 mm (mean ± standard error of the mean) and 87.2 ± 3.5 mm in length, respectively. The maximum anteroposterior diameters of the upper and lower parts of the uterine cavity were 23.1 ± 2.6 and 76.0 ± 3.0 mm, respectively, and the largest transverse diameters were 67.3 ± 1.9 and 81.1 ± 2.3 mm, respectively. The group that showed CE into the upper uterine cavity had significantly larger qualitative parameters of the upper uterine cavity compared to the group with CE into the lower uterine cavity. The gate from the lower uterine cavity toward the upper uterine cavity was narrow (anteroposterior diameter of 22.6 ± 2.0 mm, transverse diameter of 40.7 ± 3.3 mm), and the intrauterine balloon was always found in the lower uterine cavity on the CT scan. The upper uterine body was characterized by a flat oval-shaped cavity (xy plane), thick uterine wall, and lack of uniformity among bleeding sites (z = 62.4 ± 14.8 mm). In contrast, the lower uterine cavity was a circular shape (xy plane) with thin walls, and bleeding sites were located at lateral sides around the level of the internal os (z = -18.8 ± 4.9 mm).Conclusions: Atonic PPH has a significant subtype, named "PRACE," which is characterized by PPH, resistance to treatment, and arterial CE. The need for embolization can be predicted by the presence of arterial bleeding and its location, along with the shape of the uterine cavity.
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Affiliation(s)
- Asami Ikeda
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | | | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Kyoko Kameyama Nakao
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Akihito Horie
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Tsukasa Baba
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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Escobar MF, Fernández Pérez PA, Carvajal JA, Burgos JM, Messa A, Echavarria MP, Nieto A, Montes D, Miller S, Hurtado DF. Impact of nonpneumatic antishock garment in the management of patients with hypoperfusion due to massive postpartum hemorrhage. J Matern Fetal Neonatal Med 2019; 33:3086-3090. [PMID: 30632844 DOI: 10.1080/14767058.2019.1568982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objective of this article was to compare hemodynamic and perfusion parameters as well as the clinical outcomes in critically ill patients with postpartum hemorrhage (PPH) who received treatment with a nonpneumatic antishock garment (NASG) as part of an intervention package, with a group of patients in similar conditions who did not receive an NASG.Methods: This observational study analyzed a historic cohort of 154 patients with PPH, secondary hypovolemic shock and signs of hypoperfusion who were admitted to this institution from 2012 to 2015. Group 1 (n= 77) was managed with NASG and Group 2 (n = 77) received interventions other than NASG. Hypoperfusion markers and maternal outcomes were compared in both groups.Results: Of 154 patients included in the analysis, 36.4% required a total abdominal hysterectomy (TAH) to achieve hemorrhage control, 98.2% of whom belonged to Group 2 and 1.8% to Group 1 (p = .001). The use of blood products was more common in Group 2 (p < .001), as was the administration of vasoactive agents. The mean number of days of hospitalization at the Obstetric High Dependency Unit (OHDU) was significantly lower in Group 1 and reached a statistically significant p value. Only two cases of maternal death occurred in Group 2.Discussion: The use of NASG in the management of PPH is a cost-effective strategy for patients with severe shock and signs of hypoperfusion and is optimal in a limited-resource scenario. In this study, the use of NASG was related to better outcomes in a statistically significant manner with better results regarding maternal outcomes such as uterine preservation and decreased transfusion requirements and hospital days.Conclusions: NASG, associated with the use of uterotonic agents and other strategies for PPH control, is a safe tool that helps reduce morbimortality in critically ill patients with PPH.
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Affiliation(s)
- Maria Fernanda Escobar
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia.,Departament of Health Science, Faculty of Medicine, ICESI University, Cali, Colombia
| | | | - Javier Andrés Carvajal
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia
| | - Juan Manuel Burgos
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia
| | - Adriana Messa
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia
| | - Maria Paula Echavarria
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia
| | - Albaro Nieto
- Department of Gynecology and Obstetrics, Fundación Clínica Valle Del Lili, Cali, Colombia
| | - Daniela Montes
- Departament of Health Science, Faculty of Medicine, ICESI University, Cali, Colombia
| | - Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health and Policy, School of Medicine, University of California, San Francisco, CA, USA
| | - David Felipe Hurtado
- Departament of Health Science, Faculty of Medicine, ICESI University, Cali, Colombia
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Liao Q, Yan J, Zhou Z, Luo J, Han Q, Zhang Q, Chen R. Relationship between uterine smooth muscular CPI-17-signal pathway-mediated Ca 2+ sensitivity changes and uterine atony-induced postpartum haemorrhage. J OBSTET GYNAECOL 2018; 39:302-307. [PMID: 30428734 DOI: 10.1080/01443615.2018.1504206] [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] [Indexed: 10/27/2022]
Abstract
This study aimed to investigate the changes of protein kinase C (PKC)-potentiated phosphatase inhibitor of 17 ku (CPI-17) expression, PKC activity and Rho kinase activity in the maternal uterine smooth muscle (USM), and their roles in the occurrence of uterine atony-induced postpartum haemorrhage (UAI-PPH). Sixty primiparaes who had a caesarean section performed were divided into the case group (with UAI-PPH) and the control group (the uterine contraction was good, without the PPH). The USM-p-CPI-17 (Thr38) protein levels, the activities of PKC and Rho kinase in the case group and the control group were 0.43 ± 0.20, 4.30 ± 0.91, 10.85 ± 1.70 and 0.67 ± 0.32, 0.099 ± 0.028, 0.20 ± 0.071, respectively (p < .05). The down-regulated expression of CPI-17 phosphorylated proteins might be one of the important factors of UAI-PPH, while the activity reduction of PKC and Rho kinase might be the reason that led to the phosphorylation level reduction of USM-CPI-17 in UAI-PPH. Impact Statement What is already known on this subject? The studies have shown that in the late pregnancy period, the total protein and phosphorylated protein of myometrial CPI-17 are significantly higher than in the non-pregnancy state, and they were all involved in regulating and enhancing the Ca2+ sensitivity of USMC during the pregnancy. The data regarding the CPI-17-signal pathway-mediated Ca2+ sensitivity in UAI-PPH is sparse. What do the results of this study add? We have shown that the down-regulated expression of CPI-17 phosphorylated proteins might be one of the important factors of UAI-PPH, while the activity reduction of PKC and Rho kinase might be the reason that led to the phosphorylation level reduction of USM-CPI-17 in UAI-PPH. What are the implications of these findings for clinical practice and/or further research? Further studies are needed to confirm the pathogenesis of CPI-17-signal pathway-mediated Ca2+ sensitivity in UAI-PPH.
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Affiliation(s)
- Qiuping Liao
- a Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital , Affiliated Hospital of Fujian Medical University , Fuzhou , PR China
| | - Jianying Yan
- a Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital , Affiliated Hospital of Fujian Medical University , Fuzhou , PR China
| | - Zhimei Zhou
- b Second Affiliated Hospital of Fujian Medical University , Quanzhou , PR China
| | - Jinying Luo
- a Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital , Affiliated Hospital of Fujian Medical University , Fuzhou , PR China
| | - Qing Han
- a Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital , Affiliated Hospital of Fujian Medical University , Fuzhou , PR China
| | - Qinjian Zhang
- a Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital , Affiliated Hospital of Fujian Medical University , Fuzhou , PR China
| | - Rongxin Chen
- a Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital , Affiliated Hospital of Fujian Medical University , Fuzhou , PR China
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Songthamwat S, Songthamwat M. Uterine flexion suture: modified B-Lynch uterine compression suture for the treatment of uterine atony during cesarean section. Int J Womens Health 2018; 10:487-492. [PMID: 30197543 PMCID: PMC6113941 DOI: 10.2147/ijwh.s170460] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to report our clinical experience of applying a uterine flexion suture, which was modified from the B-Lynch uterine compression suture, for treating uterine atony during cesarean section. Materials and methods This is a retrospective descriptive study describing the use of a new technique, uterine flexion suture, for treating uterine atony during cesarean section. The study period was from January 2009 to December 2017 at Udonthani Hospital, Udonthani, Thailand. Uterine atony during cesarean section was treated by manual compression, intravenous oxytocin, methylergonovine maleate, and prostaglandins and then was observed for 10-15 minutes before applying a uterine flexion suture in the failed medical treatment cases. The patients were observed for vaginal bleeding, hematometra, and infection after operation. Uterine ultrasound scan results on days 1, 7, and 30 postoperation were also reviewed. Results Fifty-seven patients with uterine atony during cesarean delivery received the uterine flexion suture. The mean age of patients was 27.0 (15-44 years). Thirty-four patients were primipara. The indications for cesarean section were cephalopelvic disproportion in 27 (47.4%) cases, and previous cesarean section in 11 (19.3%) cases. Neither postoperative excessive bleeding nor hysterectomy was observed. There was no hematometra or serious postoperative complication after surgery. The estimated time for uterine flexion suture is only 2-3 minutes and was very easy to perform. Conclusion Uterine flexion suture technique, which was modified from the B-Lynch suture, was inexpensive, quick, and effective in the treatment of atonic postpartum uterus in women undergoing cesarean section.
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Affiliation(s)
- Srisuda Songthamwat
- Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand,
| | - Metha Songthamwat
- Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand,
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Shih JC, Liu KL, Kang J, Yang JH, Lin MW, Yu CU. 'Nausicaa' compression suture: a simple and effective alternative to hysterectomy in placenta accreta spectrum and other causes of severe postpartum haemorrhage. BJOG 2018; 126:412-417. [PMID: 30009547 PMCID: PMC6585672 DOI: 10.1111/1471-0528.15410] [Citation(s) in RCA: 21] [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] [Accepted: 07/06/2018] [Indexed: 01/09/2023]
Abstract
Postpartum haemorrhage (PPH), especially resulting from placenta accreta spectrum (PAS), has become a worldwide concern in maternity care. We describe a novel method of uterine compression sutures (the ‘Nausicaa’ technique) as an alternative to hysterectomy for patients who have suffered from major PPH. We applied this technique in 68 patients with major PPH during caesarean section (including 43 patients with PAS, 20 patients with placenta praevia totalis, and five patients with uterine atony), and none of these patients required further hysterectomy. We conclude that our Nausicaa suture is a simple and feasible alternative to hysterectomy in patients suffering from major PPH.
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Affiliation(s)
- J-C Shih
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - K-L Liu
- Department of Radiology, National Taiwan University Hospital Taipei, National Taiwan University College of Medicine, Taipei, Taiwan
| | - J Kang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - J-H Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - M-W Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - C-U Yu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Khan ES, Basharat A. Successful use of balloon tamponade in the management of postpartum hemorrhage in a case of bicornuate uterus. SAGE Open Med Case Rep 2018; 6:2050313X18776174. [PMID: 29796270 PMCID: PMC5960844 DOI: 10.1177/2050313x18776174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [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: 11/14/2017] [Accepted: 04/16/2018] [Indexed: 11/15/2022] Open
Abstract
Worldwide 50%-70% of all cases of maternal morbidity have been attributed to postpartum hemorrhage. This report discusses a case of bicornuate uterus in a term pregnancy. The delivery was by cesarean section, which was followed by massive postpartum hemorrhage, managed successfully with balloon tamponade. This is the second reported case of successful management of post partum hemorrhage in a bicornuate uterus with balloon tamponade. A 22-year-old primigravida at 39 weeks of gestational age presented with vaginal leaking of clear fluid. Cesarean section was done due to meconium stained liquor in early labor; with an incidental finding of bicornuate uterus followed by massive postpartum hemorrhage managed successfully with balloon tamponade. The use of uterine balloon tamponade as an effective method to control postpartum hemorrhage has been studied extensively, but use in cases of hemorrhage associated with uterine malformations has not been reported much in literature. Use of uterine balloon tamponade in case of uterine malformations has been highlighted in our case as an effective non-surgical method to control hemorrhage.
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Affiliation(s)
- Erum Saleem Khan
- Department of Obstetrics & Gynecology, The Aga Khan University Hospital, Karachi, Pakistan
- Erum Saleem Khan, Department of Obstetrics & Gynecology, 515/516, Goldstreet Aga Khan Hospital for Women, Garden, 74800 Karachi, Pakistan.
| | - Ayesha Basharat
- Department of Obstetrics and Gynecology, Al Nafees Medical College & Hospital, Isra University, Islamabad, Pakistan
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Abstract
BACKGROUND Severe secondary or delayed postpartum hemorrhage (PPH) is rare and affects 0.23-3% of all pregnancies. It happens between 24 hours to 12 weeks postdelivery. These PPHs occur more often during normal vaginal delivery; only a small subset of these PPHs occur after cesarean section. The top differential diagnoses of both primary and secondary PPH are different, and as a result, the management may be different. Although uterine atony causes 80% of primary PPHs, extensive literature review exposed the rarity of it in the setting of secondary PPH. CASE REPORT A 27-year-old woman presented to the emergency department 1 week after a cesarean section for severe vaginal bleeding that started an hour earlier. The patient required rigorous uterine massage for approximately 30 min along with oxytocin, carboprost, methergine, and misopristol before bleeding subsided. She required 1 unit of O- blood transfusion during resuscitation and still had a hemoglobin drop of 2.7 g/dL from arrival to after bleeding subsided. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: PPH is a life-threatening condition that emergency physicians rarely encounter and may be uncomfortable managing. It is important to be familiar with the differential diagnosis of both primary and secondary PPH and the management of each of the causes.
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Affiliation(s)
- Nirav Patel
- Emergency Medicine Department, Coney Island Hospital, Brooklyn, New York
| | - Michael Radeos
- Emergency Medicine Department, Coney Island Hospital, Brooklyn, New York
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Schlembach D, Helmer H, Henrich W, von Heymann C, Kainer F, Korte W, Kühnert M, Lier H, Maul H, Rath W, Steppat S, Surbek D, Wacker J. Peripartum Haemorrhage, Diagnosis and Therapy. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry No. 015/063, March 2016). Geburtshilfe Frauenheilkd 2018; 78:382-399. [PMID: 29720744 PMCID: PMC5925693 DOI: 10.1055/a-0582-0122] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/08/2018] [Accepted: 02/26/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose
This is an official interdisciplinary guideline, published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (OEGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline was developed for use in German-speaking countries and is backed by the German Society of Anaesthesiology and Intensive Medicine (DGAI), the Society of Thrombosis and Haemostasis Research (GTH) and the German Association of Midwives. The aim is to provide a consensus-based overview of the diagnosis and management of peripartum bleeding obtained from an evaluation of the relevant literature.
Methods
This S2k guideline was developed from the structured consensus of representative members of the various professional associations and professions commissioned by the Guideline Commission of the DGGG.
Recommendations
The guideline encompasses recommendations on definitions, risk stratification, prevention and management.
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Affiliation(s)
| | - Hanns Helmer
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Wien, Austria
| | - Wolfgang Henrich
- Klinik für Geburtsmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian von Heymann
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Franz Kainer
- Geburtshilfe und Pränatalmedizin, Klinik Hallerwiese, Nürnberg, Germany
| | | | - Maritta Kühnert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Gießen-Marburg, Marburg, Germany
| | - Heiko Lier
- Klinik für Anästhesie und operative Intensivmedizin, Universitätsklinik Köln, Köln, Germany
| | - Holger Maul
- Geburtshilfe & Pränatalmedizin, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Werner Rath
- Gynäkologie und Geburtshilfe, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | | | - Daniel Surbek
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und feto-maternale Medizin, Bern, Switzerland
| | - Jürgen Wacker
- Klinik für Gynäkologie und Geburtshilfe, Fürst-Stirum-Klinik Bruchsal, Bruchsal, Germany
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Kilicci C, Sanverdi I, Bostanci E, Abide CY, Eser SK. Uterine torsion of 720 degrees in the third trimester of pregnancy and accompanying bladder torsion: a case report. Pan Afr Med J 2018; 29:175. [PMID: 30050639 PMCID: PMC6057591 DOI: 10.11604/pamj.2018.29.175.14101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/12/2018] [Indexed: 11/21/2022] Open
Abstract
Partial rotation of the uterus not more than 45 degrees to the right is considered to be normal. Since all cases are not reported, the incidence of uterine torsion in pregnancy is not known exactly. In the literature, there have been reports of cases with uterine torsion ranging from 45 to 720 degrees. This is a case report of uterine torsion of 720 degrees with accompanying bladder torsion, developing after two caesarean sections, and developing of uterine atony after the operation.
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Affiliation(s)
- Cetin Kilicci
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Ilhan Sanverdi
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Evrim Bostanci
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Cigdem Yayla Abide
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Semra Kayatas Eser
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
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Şahin H, Soylu Karapınar O, Şahin EA, Dolapçıoğlu K, Baloğlu A. The effectiveness of the double B-lynch suture as a modification in the treatment of intractable postpartum haemorrhage. J OBSTET GYNAECOL 2018; 38:796-799. [PMID: 29557226 DOI: 10.1080/01443615.2017.1420046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A broader range of more effective compression techniques are needed in the patients who have an intractable postpartum haemorrhage due to uterine atony despite medical treatment and B-Lynch sutures. The aim of this study was to report the outcome of a series of patients with haemorrhage who were managed by double B-Lynch suture. Fourteen patients who were treated in a tertiary hospital between July 2010 and February 2015 were included in the study. The intractable haemorrhage rate was 0.35% over 5 years (14/4000 births). Bleeding was controlled in all the patients with a double B-Lynch suture. The mean age of the patients was 24 ± 3.4 years. The mean estimated blood loss was 1696 ± 272.075 mL, and the mean transfusion rate was 4.2 ± 2.5 units. Pregnancy was observed in five patients at follow up. The double B-Lynch suture seems to be an effective and reliable solution to an intractable postpartum haemorrhage resulting from uterine atony and has no unfavourable impacts on fertility. It should be considered before the use of any aggressive surgical techniques such as a hypogastric artery ligation or a hysterectomy. This the first study to investigate the effectiveness of the double B-Lynch suture, and we showed that the hysterectomy and/or hypogastric artery ligation rate can be decreased by adding a second B-Lynch suture in cases where the medical treatment or a single B-Lynch has failed. Impact statement What is already known on the subject? Uterine atony is the most common cause of a primary postpartum haemorrhage. When a simple massage of the uterus and medication failed to manage this condition, various surgical solutions have been sought, including uterine compression sutures, uterine artery ligation, devascularisation of the uterus, internal iliac artery ligation and, ultimately, a hysterectomy. The B-Lynch suturing technique is particularly useful because of its simplicity of application, life-saving potential, relative safety and capacity for preserving the uterus and subsequent fertility. To-date, this suturing technique, when applied correctly, has been successful with no problems and no apparent complications. However in the cases of when it falls, usually a hysterectomy or a hipogastric artery ligation is preferred. What does this study add? A 'double B-Lynch suture seems to be an effective and reliable method in an intractable postpartum haemorrhage due to a uterine atony and has no unfavourable impact on fertility'. What are the implications of these findings for clinical practice? The double B-Lynch suture seems to be an effective, reliable and technically easy method. With this aspect, it might be considered before any aggressive surgical techniques, such as a hypogastric artery ligation and hysterectomy in selected cases.
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Affiliation(s)
- Hanifi Şahin
- a Department of Gynecologic Oncology , Ankara Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences , Ankara , Turkey
| | - Oya Soylu Karapınar
- b Department of Obstetrics and Gynecology , Mustafa Kemal University Faculty of Medicine , Hatay , Turkey
| | - Eda Adeviye Şahin
- c Dr. Sami Ulus Burak Women's Health Training and Research Hospital, University of Health Sciences , Ankara , Turkey
| | - Kenan Dolapçıoğlu
- b Department of Obstetrics and Gynecology , Mustafa Kemal University Faculty of Medicine , Hatay , Turkey
| | - Ali Baloğlu
- d Izmir Private Gynecology Clinic , Izmir , Turkey
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Ahmadi F. A comparative study on infusion of usual dose of oxytocin and 80 units dose of oxytocin in the prevention of postpartum hemorrhage in cesarean section. J Adv Pharm Technol Res 2018; 9:102-106. [PMID: 30338236 PMCID: PMC6174700 DOI: 10.4103/japtr.japtr_297_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 12/04/2022] Open
Abstract
Postpartum hemorrhage is one of the main causes of mothers’ death mostly in developing country. The frequency of postpartum hemorrhage after natural pregnancy and cesarean are reported 2%–4% and 6%, respectively. The main goal of this study is to compare two regimens of oxytocine: One with high dose and the other with normal one to prevent uterine atony. The study has been done via a clinical trial method on 150 pregnant women in Zahedan, Iran. The society is randomly divided into two groups. The patients having risk factors of uterine atony and postpartum hemorrhage were omitted from the list. Oxytocin with 80 and 30 dose was, respectively, infused in 500 cc Ringer serum for control and witness group immediately after infant emersion during a period of 30 min. Decline of hemoglobin 6 and 24 h after cesarean section, uterine atony, blood infusion, and extra uterotonic drug needs after oxytocin infusion have been measured for both groups. The data have been analyzed using Chi-square via SPSS software. The result indicates that there exist meaningful differences between control and witness group in uterine atony and extra utertonic drug need while and after surgery (0 as compared with 22.6% and P = 0); whereas there is no significant difference between control and trial group in decline of hemoglobin 6 and 24 h after cesarean section (P = 0.714 and 0.231, respectively). It means that oxytocin infusion with 80 dose has a good impact on the above four variances. It is recommended that oxytocin infusion with 80 dose during a period of 30 min could be a good substitution for oxytocin infusion with 30 dose for the prevention of uterine atony during and after cesarean delivery, especially when utertonic drug is not accessible and in the case of counterindication of other drugs’ use.
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Affiliation(s)
- Fatemeh Ahmadi
- Department of Gynecology and Obstetrics, Zahedan University of Medical Sciences, Zahedan, Iran
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Aguilar-Crespo A, Morales-Roselló J, Sánchez-Ajenjo C, Valle-Tejero A, García-Marcos R, Perales-Marín A. Postpartum hemorrhage with pelvic arterial embolization, study of 33 cases. J Matern Fetal Neonatal Med 2017; 32:573-578. [PMID: 28965438 DOI: 10.1080/14767058.2017.1387527] [Citation(s) in RCA: 3] [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: 10/18/2022]
Abstract
OBJECTIVE To describe our cases of postpartum hemorrhage (PPH) with pelvic arterial embolization (PAE). MATERIAL AND METHODS All patients with PPH who underwent PAE in our center in the interval 2011-1016 were retrospectively studied, evaluating the technical procedure, clinical results, and subsequent fertility. RESULTS There were 33 cases of PPH with PAE. The majority occurred in primiparous women (N = 22, 66.6%) who delivered vaginally (N = 20, 61%). In addition, most PPH with PAE cases had an early onset (N = 26, 79%) and were caused by uterine atony (N = 14, 42.4%). Success of PAE occurred in 27 (81.8%) cases and a satisfactory clinical follow-up was the rule, with 21 (64%) women recovering their normal menstruation, and six (18.2%) becoming pregnant in the following years. CONCLUSIONS PAE is a safe and efficacious technique with minor complications. Moreover, it allows conservation of the uterus with preservation of fertility.
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Affiliation(s)
- Alejandra Aguilar-Crespo
- a Obstetrics and Gynecology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
| | - José Morales-Roselló
- a Obstetrics and Gynecology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
| | - Carlos Sánchez-Ajenjo
- a Obstetrics and Gynecology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
| | - Ana Valle-Tejero
- a Obstetrics and Gynecology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
| | - Raúl García-Marcos
- b Vascular and Interventional Radiology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
| | - Alfredo Perales-Marín
- a Obstetrics and Gynecology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
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Sobkowski M, Celewicz Z, Kalinka J, Szymanowski K, Serafin M, Śmieja K, Grzymała-Figura A, Pacocha K, Pieniążek I, Walczak J, Żyła A, Bierut A. Costs of the use of carbetocin in the prevention of uterine atony following delivery of the infant by Caesarean section - retrospective multicenter study. Ginekol Pol 2016; 87:621-628. [PMID: 27723068 DOI: 10.5603/gp.2016.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/31/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the costs of using carbetocin in the prevention of uterine atony following delivery of the infant by Cesarean section (C-section) under epidural or spinal anesthesia with standard methods of prevention (SMP). MATERIAL AND METHODS This retrospective multicenter study was based on data from three medical centers. A questionnaire was developed to gather patient records on consumption and costs of resources related to C-section, prevention of uterine atony and postpartum hemorrhage (PPH) treatment. Six subpopulations were considered, depending on patient characteristics. The analysis covered two perspectives: that of the hospital and of the public payer. RESULTS The subpopulations were homogenous, which was a premise for pooling the data. The use of carbetocin in the prevention of uterine atony following Cesarean section generates savings for hospital in comparison with SMP (oxytocin) in 5 of 6 subpopulations. The biggest savings were observed amongst patients who experienced severe PPH and reached 2.6-6.2 thousand PLN per patient. Costs of services related to C-section borne by the hospitals were higher than the refund received from a public payer. The greatest underestimation reached 12.1 thousand PLN per patient. Nevertheless, loss generated by this underfunding was lower in carbetocin versus oxytocin group. CONCLUSIONS The use of carbetocin instead of SMP gives hospitals an opportunity to make savings as well as to reduce losses resulting from the underfunding of the services provided by the National Health Fund.
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Phi Hung L, Diem Nghi T, Hoang Anh N, Van Hieu M, Thien Luan N, Phuoc Long N, Trong Thach T. Case Report: Postpartum hemorrhage associated with Dengue with warning signs in a term pregnancy and delivery. F1000Res 2015; 4:1483. [PMID: 26925224 PMCID: PMC4712770 DOI: 10.12688/f1000research.7589.1] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 11/20/2022] Open
Abstract
Background: Dengue infection during peripartum period, although rare in endemic regions, has challenged clinicians regarding its management, especially if a parturient woman experiences postpartum hemorrhage due to a classical risk factor of maternal bleeding. Case: A full-term pregnant Vietnamese woman was diagnosed with polyhydramnios and Dengue with warning signs (DWS). She was administered platelet transfusion prior to delivery and then gave birth to a healthy newborn. After active management of the third stage of labor, the patient suffered a postpartum hemorrhage which was caused by uterine atony and accompanied with thrombocytopenia. Therefore, we decided to administer uterotonic drugs and additionally transfuse platelets. Conclusion: We describe a case of postpartum hemorrhage caused by uterine atony and coinciding with Dengue infection during delivery period, which is a rare clinical entity. With timely detection and management, the patient was finally discharged without complications.
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Affiliation(s)
- Le Phi Hung
- University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
| | - Tran Diem Nghi
- School of Medicine, Vietnam National University, Ho Chi Minh, Vietnam
| | - Nguyen Hoang Anh
- School of Medicine, Vietnam National University, Ho Chi Minh, Vietnam
| | - Mai Van Hieu
- School of Medicine, Vietnam National University, Ho Chi Minh, Vietnam
| | | | | | - Than Trong Thach
- University of Medicine and Pharmacy, Ho Chi Minh, Vietnam; Hung Vuong Hospital, Ho Chi Minh, Vietnam
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47
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Todo Y, Tamura N, Itoh H, Ikeda T, Kanayama N. Therapeutic application of C1 esterase inhibitor concentrate for clinical amniotic fluid embolism: a case report. Clin Case Rep 2015; 3:673-5. [PMID: 26273468 PMCID: PMC4527822 DOI: 10.1002/ccr3.316] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/06/2015] [Accepted: 05/21/2015] [Indexed: 11/11/2022] Open
Abstract
We present the successful application of C1 esterase inhibitor (C1INH) concentrate to a patient with clinical amniotic fluid embolism (AFE).
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Affiliation(s)
- Yusuke Todo
- Department of Obstetrics & Gynaecology, Hamamatsu University School of Medicine Hamamatsu, Shizuoka, Japan
| | - Naoaki Tamura
- Department of Obstetrics & Gynaecology, Hamamatsu University School of Medicine Hamamatsu, Shizuoka, Japan
| | - Hiroaki Itoh
- Department of Obstetrics & Gynaecology, Hamamatsu University School of Medicine Hamamatsu, Shizuoka, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics & Gynaecology, Mie University School Mie, Japan
| | - Naohiro Kanayama
- Department of Obstetrics & Gynaecology, Hamamatsu University School of Medicine Hamamatsu, Shizuoka, Japan
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Matsubara S, Takahashi H, Lefor AK. A Commentary on: "A New Removable Uterine Compression by a Brace Suture in the Management of Severe Postpartum Hemorrhage". Front Surg 2015; 2:17. [PMID: 26029699 PMCID: PMC4429487 DOI: 10.3389/fsurg.2015.00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/27/2015] [Indexed: 12/03/2022] Open
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University , Tochigi , Japan
| | - Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University , Tochigi , Japan
| | - Alan K Lefor
- Department of Surgery, Jichi Medical University , Tochigi , Japan
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49
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Butwick AJ, Carvalho B, Blumenfeld YJ, El-Sayed YY, Nelson LM, Bateman BT. Second-line uterotonics and the risk of hemorrhage-related morbidity. Am J Obstet Gynecol 2015; 212:642.e1-7. [PMID: 25582104 DOI: 10.1016/j.ajog.2015.01.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/10/2014] [Accepted: 01/06/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Uterine atony is a leading cause of postpartum hemorrhage. Although most cases of postpartum hemorrhage respond to first-line therapy with uterine massage and oxytocin administration, second-line uterotonics including methylergonovine and carboprost are integral for the management of refractory uterine atony. Despite their ubiquitous use, it is uncertain whether the risk of hemorrhage-related morbidity differs in women exposed to methylergonovine or carboprost at cesarean delivery. STUDY DESIGN We performed a secondary analysis using the Maternal-Fetal Medicine Units Network Cesarean Registry. We identified women who underwent cesarean delivery and received either methylergonovine or carboprost for refractory uterine atony. The primary outcome was hemorrhage-related morbidity defined as intraoperative or postoperative red blood cell transfusion or the need for additional surgical interventions including uterine artery ligation, hypogastric artery ligation, or peripartum hysterectomy for atony. We compared the risk of hemorrhage-related morbidity in those exposed to methylergonovine vs carboprost. Propensity-score matching was used to account for potential confounders. RESULTS The study cohort comprised 1335 women; 870 (65.2%) women received methylergonovine and 465 (34.8%) women received carboprost. After accounting for potential confounders, the risk of hemorrhage-related morbidity was higher in the carboprost group than the methylergonovine group (relative risk, 1.7; 95% confidence interval, 1.2-2.6). CONCLUSION In this propensity score-matched analysis, methylergonovine was associated with reduced risk of hemorrhage-related morbidity during cesarean delivery compared to carboprost. Based on these results, methylergonovine may be a more effective second-line uterotonic.
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Affiliation(s)
- Alexander J Butwick
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA.
| | - Brendan Carvalho
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA
| | - Yair J Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Yasser Y El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Lorene M Nelson
- Department of Health Research Policy, Stanford University School of Medicine, Stanford, CA
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Department of Anesthesiology, Critical Care Medicine, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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50
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Ferrazzani S, Iadarola R, Perrelli A, Botta A, Moresi S, Salvi S, Santucci S, Degennaro VA, De Carolis S. Use of an intrauterine inflated catheter balloon in massive post-partum hemorrhage: a series of 52 cases. J Obstet Gynaecol Res 2015; 40:1603-10. [PMID: 24888923 DOI: 10.1111/jog.12404] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/14/2014] [Indexed: 11/27/2022]
Abstract
AIM Massive post-partum hemorrhage (PPH) is an important cause of maternal death that occurs as a complication of delivery. We report a large case series to evaluate the efficacy of uterine balloon tamponade to treat PPH avoiding hysterectomy. MATERIAL AND METHODS This prospective study was conducted in two Italian hospitals (from December 2002 to July 2012). Fifty-two patients with PPH not responsive to uterotonics were treated by Rusch balloon. A follow-up was conducted among the study population to assess the subsequent fertility. RESULTS The most frequent cause of PPH was atony (59.6%), followed by placenta previa (21.2%), placenta accreta (9.6%), and placenta previa and accreta (9.6%). The balloon success rate to control hemorrhage was 75%. From the sample of 52 patients, 13 patients needed additional procedures. In three failure cases, other conservative techniques were used and the overall effectiveness of them was 80.7%. The follow-up group consisted of 31 women. Of these women, 24 women (77.4%) had no further pregnancies, but only one due to sterility. Four of seven patients with subsequent pregnancies made it to term without complications. CONCLUSIONS The Rusch balloon is effective in controlling non-traumatic PPH in 75% of cases. It is simple to use, readily available and cheap. If necessary, this technique does not exclude other procedures. We suggest that this balloon should be included routinely in the PPH protocol.
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Affiliation(s)
- Sergio Ferrazzani
- Department of Obstetrics and Gynaecology, Catholic University of Sacred Heart
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