scholarly journals Progressive Devascularization: A Novel Surgical Approach for Placenta Previa

2018 ◽  
Vol 08 (04) ◽  
pp. e223-e226
Author(s):  
Antonio Saad ◽  
Nathan Kirsch ◽  
George Saade ◽  
Gary Hankins
Keyword(s):  
Surgical Approach ◽  
Antenatal Diagnosis ◽  
Placenta Previa ◽  
Multiple Organ ◽  
Artery Ligation ◽  
Peripartum Hysterectomy ◽  
Cesarean Deliveries ◽  
Uterine Artery Ligation ◽  
Peripartum Hemorrhage ◽  
Life Threatening

Background The gold standard for antenatal diagnosis of placenta previa is the transvaginal ultrasonography. In placenta previa cases, separation of placental and uterine tissues is challenging even for the most experienced surgeons. Life-threatening obstetrical complications from cesarean deliveries with placenta previa include peripartum hemorrhage, coagulopathy, blood transfusion, peripartum hysterectomy, and multiple organ failure. Cases We detailed the 3 cases of placenta previa that underwent bilateral uterine artery ligation; if hemostasis was not achieved, horizontal mattress sutures were placed in the lower uterine segment. All patients were discharged with minimal morbidity. Conclusion For patients with placenta previa and low risk for placenta creta, counseling should include the risk for maternal morbidity and criteria for pursuing peripartum hysterectomy. Our devascularization, a stepwise surgical approach, shows promising outcomes in placenta previa cases. Précis We propose a novel surgical approach, using a progressive devascularization surgical technique, for management of women with placenta previa, undergoing cesarean delivery.

scholarly journals Massive Secondary Postpartum Hemorrhage with Uterine Artery Pseudoaneurysm after Cesarean Section

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
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.

scholarly journals Evaluation of Parameters that Influence Morbidity in Peripartum Hysterectomy

2015 ◽  
Vol 9 (3) ◽  
pp. 234-238
Author(s):  
Panos Antsaklis ◽  
George Daskalakis ◽  
Vasilios Pergialiotis ◽  
Alexandros Rodolakis ◽  
George Vlachos ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Obstet Gynecol ◽  
Postoperative Morbidity ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Maternity Hospital ◽  
Artery Ligation ◽  
Peripartum Hysterectomy ◽  
Evaluation Of Parameters ◽  
Perioperative Blood Transfusion

ABSTRACT Objective To evaluate which factors affect the intraoperative and postoperative morbidity in cases of peripartum hysterectomy. Study design A retrospective study of all cases of peripartum hysterectomy performed during a 5-year period (January 2008–June 2013) in a tertiary maternity hospital. Results A total of 22,437 deliveries were reviewed and 63 cases of peripartum hysterectomy (2.8/1000) were identified. The indications for peripartum hysterectomy included: uterine atony (10 cases—15.9%), placenta accreta (21 cases—33.3%), placenta previa (30 cases—47.6%) and cervical pregnancy (2 cases—3.2%). Significantly higher rates of perioperative blood transfusion were noted in the emergency cases group, compared to the elective hysterectomies. Hypogastric artery ligation did not have any significant impact on the outcome. Preoperative bilateral ureteral catheterization was associated with lower need for blood transfusion (p < 0.001), and with less complications, although this was not statistically significant. Conclusion Maternal morbidity is significantly higher in emergency cases of peripartum hysterectomies compared to expected-planned cases. How to cite this article Daskalakis G, Antsaklis P, PergialiotisV, Rodolakis A, Vlachos G, Loutradis D, Papantoniou N. Evaluation of Parameters that Influence Morbidity Peripartum Hysterectomy. Donald School J Ultrasound Obstet Gynecol 2015;9(3):234-238.

scholarly journals The bleeding mother and her baby: a study to determine the fetomaternal outcome in cases of placenta previa

2020 ◽  
Vol 9 (9) ◽  
pp. 3775
Author(s):  
Preeti Frank Lewis ◽  
Sana Tarannum Bijapur ◽  
Deepika Gurnani
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Uterine Artery ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Previous History ◽  
Fetal Outcome ◽  
Care Hospital ◽  
Artery Ligation ◽  
Uterine Artery Ligation

Background: Placenta previa is one of the major causes for obstetric hemorrhagic morbidity and mortality with increasing incidence in recent times. This study aims at determining risk factors, maternal and fetal outcome associated with placenta previa.Methods: This was an observational, retrospective study conducted at a tertiary care hospital in Mumbai from May 2017 to March 2020. A total of 102 women with placenta previa during the study period were included, their case records critically analyzed to identify risk factors, maternal outcome in relation with blood transfusion required, ICU admission, obstetric hysterectomy and fetal outcome pertaining to prematurity, asphyxia and mortality.Results: A total of 102 patients were analyzed. Placenta previa was more common in >26 years of age, multipara (64.7%), with previous history of caesarean sections (21.5%) and previous curettage (11.7%), 44.2% babies born were preterm, 4.4% stillbirths and 8.5% neonatal deaths. Maternal complications like antepartum hemorrhage was seen in 58.8% patients and postpartum hemorrhage in 33.3%, blood transfusion was required in only 18 patients post operatively, bladder rent was seen in 3 patients and there was no maternal mortality. 44 patients required uterine artery ligation, Ashok Anand stitch was taken in 37 patients, uterus compression sutures in 10, obstetric hysterectomy in 7 patients and internal iliac artery ligation in 2 patients.Conclusions: Early identification of women at risk, obstetric preparedness and simple techniques like uterine artery ligation, Ashok Anand stitch and uterine compression sutures can help in effectively reducing need for multiple blood transfusions and morbidity.

The Bakri balloon implementation during cesarean section without switching to the lithotomy position

2016 ◽  
Vol 5 (2) ◽  
pp. 81-84 ◽  
Author(s):  
Baris Kaya ◽  
Abdullah Tuten ◽  
Onur Guralp
Keyword(s):  
Cesarean Section ◽  
Uterine Artery ◽  
Placenta Previa ◽  
Daily Practice ◽  
Lithotomy Position ◽  
Artery Ligation ◽  
Excessive Bleeding ◽  
Uterine Artery Ligation ◽  
First Time ◽  
Bakri Balloon

Abstract Bakri balloon implementations for the conservative management of postpartum hemorrhage (PPH) have become more popular in the recent years. The procedure may be regarded as simple, however, it can become a challenging method considering an excessive bleeding patient where there is a race against time. In our daily practice we do not usually use the lithotomy position except for few conditions such as placenta previa, where the lithotomy position is necessary to apply a Bakri balloon during PPH during a cesarean section. Here we would like to present a woman with uterine atony and fundal placenta accreta bleeding, managed with the Bakri balloon without switching to the lithotomy position for the first time in the literature. The bleeding was evaluated successfully with this new method, however, a cesarean hysterectomy was necessary to achieve hemostasis despite the addition of a bilateral uterine artery ligation at the end. The decision to add a vessel ligation to the inflated Bakri balloon should be assessed carefully as uterine artery ligation may be time consuming due to effort of avoiding puncturing the balloon. On the other hand, internal illiac artery ligation may be more advantageous if the surgeon is experienced.

scholarly journals A COMBINED ULTRASOUND AND CLINICAL SCORING MODEL FOR THE PREDICTION OF PERIPARTUM COMPLICATIONS IN PREGNANCIES COMPLICATED BY PLACENTA PREVIA

2021 ◽  
pp. 73-76
Author(s):  
SHREEJI GOYAL ◽  
SUJATA SHARMA ◽  
ARVINDER SINGH ◽  
AMARJEET KAUR
Keyword(s):  
Blood Transfusion ◽  
Cesarean Delivery ◽  
Uterine Artery ◽  
Placenta Previa ◽  
Artery Ligation ◽  
Scoring Model ◽  
Uterine Artery Ligation ◽  
Clinical Scoring ◽  
History Of ◽  
Ultrasound Parameters

Introduction: Patients with placenta previa are at an increased risk of uncontrolled hemorrhage. Various clinical and ultrasound parameters can predict the risk of bleeding in these patients. Hence, the objective of our study is to develop a combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa. Methods: Fifty singleton pregnant women with placenta previa who underwent cesarean delivery in our hospital were included in the study. We collected clinical and ultrasound data prospectively, and the score was given to each parameter, and total score correlated with the occurrence of peripartum complications. Clinical parameters included age, parity, history of dilatation and evacuation, previous cesarean delivery, history of placenta previa, antepartum hemorrhage, and ultrasound parameters included type of previa, no. of lacunae in placenta, uteroplacental hypervascularity. The peripartum complications noted were the need for blood transfusion, uterine artery ligation, and cesarean hysterectomy. Results: According to the composite scoring done, uterine artery ligation was needed in more than 50% of patients at a score of 9–10. It increased to 100% as the score increased to ≥11. At a score of ≥12, hysterectomy was needed in around 75% of patients, and 100% of patients needed a blood transfusion. Univariate analysis using the Pearson Chi-square test was also done to know whether individual parameters and peripartum complications were significantly related that is p<0.05 with one another. Conclusion: The scoring system may serve to predict peripartum complications in pregnancies complicated by placenta previa.

scholarly journals A fatal toxic shock-like syndrome post COVID-19 infection in a child

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Houda Ajmi ◽  
Wissem Besghaier ◽  
Wafa Kallala ◽  
Abdelhalim Trabelsi ◽  
Saoussan Abroug
Keyword(s):  
Ejection Fraction ◽  
Pediatric Intensive Care ◽  
Fresh Frozen Plasma ◽  
Multiple Organ ◽  
Clinical Feature ◽  
Fresh Frozen ◽  
Life Threatening ◽  
High Doses ◽  
Definition Of ◽  
High Level

Abstract Background Children affected by Coronavirus disease 2019 (COVID-19) showed various manifestations. Some of them were severe cases presenting with multi-system inflammatory syndrome (MIS-C) causing multiple organ dysfunction. Case presentation We report the case of a 12-year-old girl with recent COVID-19 infection who presented with persistent fever, abdominal pain and other symptoms that meet the definition of MIS-C. She had lymphopenia and a high level of inflammatory markers. She was admitted to pediatric intensive care unit since she rapidly developed refractory catecholamine-resistant shock with multiple organ failure. Echocardiography showed a small pericardial effusion with a normal ejection fraction (Ejection Fraction = 60%) and no valvular or coronary lesions. The child showed no signs of improvement even after receiving intravenous immunoglobulin, fresh frozen plasma, high doses of Vasopressors and corticosteroid. His outcome was fatal. Conclusion Pediatric patients affected by the new COVID-19 related syndrome may show severe life-threatening conditions similar to Kawasaki disease shock syndrome. Hypotension in these patients results from heart failure and the decreased cardiac output. We report a new severe clinical feature of SARS-CoV-2 infection in children in whom hypotension was the result of refractory vasoplegia.

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