Resuscitative efficacy of hemoglobin vesicles for severe postpartum hemorrhage in pregnant rabbits

AbstractWe aimed to investigate the resuscitative efficacy of hemoglobin vesicles (HbVs) as a red blood cell (RBC) substitute for the initial treatment of severe postpartum hemorrhage (PPH). Twenty-five pregnant rabbits underwent cesarean section; uncontrolled hemorrhage was induced by transecting the right uterine artery to establish a severe PPH model. During the first 30 min, all rabbits were administered 6% hydroxyethyl starch (HES) of an equivalent volume to the hemorrhage every 5 min. Thereafter, they received any of the following three isovolemic fluids for resuscitation every 5 min: RBCs with platelet-poor plasma (RBC/PPP) (n = 8), 6% HES (n = 7), or HbVs with 25% human serum albumin (n = 10). After surgical hemostasis at 60 min, survival was monitored until 12 h. No rabbits receiving only HES infusion survived beyond 6 h, whereas all rabbits receiving RBC/PPP transfusion survived. The rabbits receiving HbV infusion showed significantly higher mean arterial pressure and hemoglobin levels than the HES-receiving rabbits, and 8 of 10 rabbits survived for 6 h. The HbV group showed significantly higher survival than the HES group but worse survival than the RBC/PPP group. In conclusion, HbV infusion for severe PPH effectively prevents lethal hemorrhagic shock in a pregnant rabbit model.

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Secondary postpartum hemorrhage due to uterine artery pseudoaneurysm

Obstetrics & Gynecology International Journal ◽

10.15406/ogij.2021.12.00550 ◽

2021 ◽

Vol 12 (2) ◽

Author(s):

Alexis Svokos MD ◽

Kendall Cunningham MD ◽

Maranda Sullivan DO ◽

Saif Ahmed MD

Keyword(s):

Pulmonary Embolism ◽

Cesarean Section ◽

Postpartum Hemorrhage ◽

Uterine Artery ◽

Artery Pseudoaneurysm ◽

Secondary Postpartum Hemorrhage ◽

The Right ◽

Uterine Artery Pseudoaneurysm

We present the case of a 26-year-old female who experienced secondary postpartum hemorrhage nine days after an uncomplicated elective repeat low transverse cesarean section. She was found to have a uterine pseudoaneurysm and underwent gel foam embolization of the right uterine artery. Subsequently, patient was diagnosed with pulmonary embolism on post-embolization day 3, and was initiated on anti-coagulation regimen.

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Uterine Artery Pseudoaneurysm Rupture as a Culprit of Postpartum Hemorrhage: Not Always after Cesarean Section

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2013.08.123 ◽

2014 ◽

Vol 46 (3) ◽

pp. e97-e98 ◽

Cited By ~ 2

Author(s):

Shigeki Matsubara ◽

Mami Kobayashi ◽

Yosuke Baba ◽

Rie Usui

Keyword(s):

Cesarean Section ◽

Postpartum Hemorrhage ◽

Uterine Artery ◽

Artery Pseudoaneurysm ◽

Uterine Artery Pseudoaneurysm

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Refractory Late Postpartum Hemorrhage Caused by Uterine Artery Pseudoaneurysms after Cesarean Section: A Case Report and Literature

Advances in Clinical Medicine ◽

10.12677/acm.2021.1110661 ◽

2021 ◽

Vol 11 (10) ◽

pp. 4507-4512

Author(s):

美玲郭

Keyword(s):

Case Report ◽

Cesarean Section ◽

Postpartum Hemorrhage ◽

Uterine Artery

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Massive Secondary Postpartum Hemorrhage with Uterine Artery Pseudoaneurysm after Cesarean Section

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/285846 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Ahmet Ozgur Yeniel ◽

Ahmet Mete Ergenoglu ◽

Ali Akdemir ◽

Elmin Eminov ◽

Fuat Akercan ◽

...

Keyword(s):

Cesarean Section ◽

Postpartum Hemorrhage ◽

Uterine Artery ◽

Angiographic Embolization ◽

Artery Ligation ◽

Artery Pseudoaneurysm ◽

Uterine Artery Ligation ◽

Life Threatening ◽

Secondary Postpartum Hemorrhage ◽

Uterine Artery Pseudoaneurysm

Uterine artery pseudoaneurysm is a rare but serious complication of cesarean section. If inadequately treated, it can lead to life-threatening postpartum hemorrhage. Herein, we report the case of a 28-year-old woman who developed secondary postpartum hemorrhage resulting from uterine artery pseudoaneurysm and cesarean scar dehiscence after cesarean section. Angiographic embolization is a safe and effective procedure for treating postpartum hemorrhage resulting from pseudoaneurysm in hemodynamically stable patients. However, uterine artery ligation may be the surgical procedure of choice for hemodynamically unstable patients when fertility preservation is desired.

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Pseudo aneurysm of the uterine artery with arteriovenous fistula after cesarean section: A rare but sinister cause of delayed postpartum hemorrhage

Journal of Clinical Ultrasound ◽

10.1002/jcu.22890 ◽

2020 ◽

Author(s):

Julian Pohlan ◽

Larry Hinkson ◽

Ulrike Wickmann ◽

Wolfgang Henrich ◽

Christian E. Althoff

Keyword(s):

Cesarean Section ◽

Arteriovenous Fistula ◽

Postpartum Hemorrhage ◽

Uterine Artery ◽

Pseudo Aneurysm

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Massive postpartum hemorrhage treated with transcatheter arterial embolization: technical aspects and long-term effects on fertility and menstrual cycle

Acta Radiologica ◽

10.1080/02841850701370683 ◽

2007 ◽

Vol 48 (6) ◽

pp. 635-642 ◽

Cited By ~ 57

Author(s):

L.-G. Eriksson ◽

A. Mulic-Lutvica ◽

L. Jangland ◽

R. Nyman

Keyword(s):

Menstrual Cycle ◽

Radiation Dose ◽

Cesarean Section ◽

Transcatheter Arterial Embolization ◽

Postpartum Hemorrhage ◽

Uterine Artery ◽

Arterial Embolization ◽

Technical Aspects ◽

Metallic Coils

Background: Transcatheter arterial embolization (TAE) is considered a safe, life-saving procedure in postpartum hemorrhage (PPH), but its long-term effect on menstruation and fertility is unclear. Purpose: To investigate technical aspects and the evaluation of complications, focused on menstrual cycle and fertility, using TAE in patients with PPH. Material and Methods: A retrospective study including 20 patients (seven with vaginal and 13 with cesarean delivery) with severe PPH treated with bilateral TAE of the uterine artery was carried out. All patients were asked to answer a questionnaire regarding their post-embolization history. In six patients, the radiation dose was measured. Results: All 20 cases underwent bilateral TAE of the uterine artery. Gelfoam was used as the embolic agent. However, after cesarean delivery in six patients who had clear contrast medium extravasation and/or pseudoaneurysm-like lesion, metallic coils had to be used in order to achieve hemostasis. No major short- or long-term complications were registered. Normal menses resumed in all patients. Four patients had a total of five full-term and two preterm pregnancies, and all delivered healthy infants by cesarean section with no recurrence of PPH. The mean radiation dose to the ovaries was 586 mGy (range 204–729 mGy). Conclusion: TAE in patients with PPH is safe and has no major short- or long-term side effects. A patient managed with TAE can expect return of normal menses and preservation of future fertility and successful pregnancies. PPH after cesarean section might need to be embolized with metallic coils in addition to Gelfoam in order to achieve secure hemostasis.

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Postpartum hemorrhage caused by uterine artery pseudoaneurysm: A case report

Case Reports in Women s Health ◽

10.1016/j.crwh.2021.e00286 ◽

2021 ◽

Vol 29 ◽

pp. e00286

Author(s):

Danielle Glassman ◽

Ruchi Karsalia ◽

Issam Moubarak ◽

Mark V. Sauer ◽

Ashima Singla

Keyword(s):

Case Report ◽

Postpartum Hemorrhage ◽

Uterine Artery ◽

Artery Pseudoaneurysm ◽

Uterine Artery Pseudoaneurysm

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Assessment the role of tranexamic acid in prevention of postpartum hemorrhage

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00154-6 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Nevein Gerges Fahmy ◽

Fahmy Saad Latif Eskandar ◽

Walid Albasuony Mohammed Ahmed Khalil ◽

Mohammed Ibrahim Ibrahim Sobhy ◽

Amin Mohammed Al Ansary Amin

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Tranexamic Acid ◽

Postpartum Hemorrhage ◽

Postoperative Bleeding ◽

Control Group ◽

Study Group ◽

Mortality And Morbidity ◽

Lower Segment Cesarean Section ◽

Prophylactic Use

Abstract Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. It is believed that hemostatic imbalance secondary to release of tissue plasminogen activator (tPA) and subsequent hyperfibrinolysis plays a major role in PPH pathogenesis. Antifibrinolytic drugs such as tranexamic acid (TXA) are widely used in hemorrhagic conditions associated with hyperfibrinolysis. TXA reduced maternal death due to PPH and its use as a part of PPH treatment is recommended, and in recent years, a number of trials have investigated the efficacy of prophylactic use of TXA in reducing the incidence and the severity of PPH. The study is aiming to assess the efficacy of tranexamic acid in reducing blood loss throughout and after the lower segment cesarean section and reducing the risk of postpartum hemorrhage. Results The amount of blood loss was significantly lower in the study group than the control group (416.12±89.95 and 688.68±134.77 respectively). Also the 24-h postoperative hemoglobin was significantly higher in the study group (11.66±0.79 mg/dl) compared to the control group (10.53±1.07mg/dl), and the 24-h postoperative hematocrit value was significantly higher in the study group (34.99±2.40) compared to control (31.62±3.22). Conclusion Prophylactic administration of tranexamic acid reduces intraoperative and postoperative bleeding in cesarean section and the incidence of postpartum hemorrhage.

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