Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa

Abstract Background Pernicious placenta previa (PPP) is the main cause of severe obstetric postpartum hemorrhage (PPH) and hysterectomy and often requires donor blood transfusion. Prophylactic internal iliac artery (IIA) balloon occlusion (BO) combined with cell salvage is increasingly being deployed in parallel transverse uterine incision (PTUI) cesarean section (CS). The aim of this study was to explore the differences in blood management in PTUI CS with or without prophylactic IIA BO and to evaluate the safety and efficacy of cell salvage to reduce the need for donor blood transfusion during PTUI CS. Methods This retrospective study included all women who were diagnosed with PPP and PA and underwent PTUI CS from October 1, 2016, to October 31, 2018. Sixty-four patients were included: 34 underwent prophylactic IIA BO (IIA group), while 30 were treated without prophylactic IIA BO (control group). The primary outcome was a composite measure of perioperative blood management outcomes, including the estimated blood loss (EBL), donor blood transfusion, salvaged blood returned, fresh frozen plasma (FFP), pre- and postoperative serum hemoglobin(Hb) and hematocrit (HCT). In addition, the baseline conditions of mother and neonates were compared. Results The EBL was significantly higher in the IIA group compared to the control group (2883.5 ML in the IIA group versus 1868.7 ML in the control group, P=0.001). Overall, the donor blood transfusion rate was 23.5% (8/34), averaging 4.2 U, in the IIA group versus 30% (9/30), averaging 3.4 U, in the control group, which were not significantly different. The FFP transfusion rate was 47%, averaging 765.6 ml, in the IIA group versus 20%, averaging 816.7 ml, in the control group. In the IIA group, 97.1% used cell savage and had salvaged blood returned, averaging 954.9 ml. In the control group, 90% had salvaged blood returned, averaging 617.9 ml. No cases of amniotic fluid embolism were observed with leukocyte depletion filters. Conclusion Prophylactic IIA BO during PTUI CS in women with PPP and PA does not lead to a statistically significant reduction in EBL. Cell salvage was associated with a reduction in the rate of donor blood transfusion during PTUI CS.

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Conservative Surgical Treatment of a Case of Placenta Accreta

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1668528 ◽

2018 ◽

Vol 40 (08) ◽

pp. 494-496 ◽

Cited By ~ 1

Author(s):

Ismail Biyik ◽

Fatih Keskin ◽

Elif Keskin

Keyword(s):

Cesarean Section ◽

Placenta Accreta ◽

Placenta Previa ◽

Placental Tissue ◽

Uterine Wall ◽

Elective Cesarean Section ◽

Triple P ◽

Cesarean Hysterectomy ◽

Uterine Incision ◽

Fertility Sparing

AbstractPlacenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending from the anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa.

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Patient blood management» strategy in pregnant women with the risk of massive obstetric bleeding

Reproductive health of woman ◽

10.30841/2708-8731.6.2021.244379 ◽

2021 ◽

Vol 6 ◽

pp. 50-55

Author(s):

S.P. Posokhova ◽

I.I. Ryazantcev ◽

N.V. Baylo ◽

I.V. Fetshenko

Keyword(s):

Pregnant Women ◽

Placenta Previa ◽

Intravenous Iron ◽

Deficiency Anemia ◽

Severe Anemia ◽

Patient Blood Management ◽

Placental Pathology ◽

Blood Management ◽

Moderate Anemia ◽

Invasive Placenta

The objective: a determination of the effectiveness of anemia treatment with intravenous iron (III) hydroxide sucrose complex in pregnant women with pathological placentation, as the first stage of “patient blood management” before delivery.Materials and methods. Among 86 pregnant women with placental pathology, 58 (70.7 %) had anemia. Severe anemia with a hemoglobin level <70 g/l was in 13 (22.4 %), moderate anemia with a hemoglobin level <90 g/l — in 19 (32.8 %). The first group included 18 (31.1 %) pregnant women with placenta previa with periodic blood loss during pregnancy. The second group consisted of 40 (68.9 %) pregnant women with invasive placenta. The gestation period in all women was 33+6 weeks. Anemia was treated by intravenous administering iron (III) hydroxide sucrose complex 3 times a week (5-7 injections).Results. The main factor that led to pathological placentation was the scar on the uterus. In pregnant women in the second group with invasive placenta, the scar on the uterus was in 38 (95 %) women. Severe anemia was present in 2 (11.1 %) pregnant women with placenta previa that was in 2.4 times less than in pregnant women with invasive placenta — 11 (27.5 %). Moderate anemia was present in 4 (22.2 %) women in the first group and in 15 (37.5 %) in the second group.In pregnant women with severe anemia, after 5–7 injections of the drug iron (III) hydroxide sucrose complex the level of hemoglobin increased significantly by 30 g/l, the number of erythrocytes increased to 2.8×1012/l, serum iron – in 2 times, the level of ferritin – to 19.6 μg/l and transferrin content decreased. For pregnant women with moderate anemia, 3–5 injections of the drug were sufficient to normalize the indicators. Normalization of blood parameters allowed to reduce the risk of bleeding, the number of blood transfusions and improve treatment outcomes.Conclusions. Timely diagnosis of the iron deficiency anemia in pregnant women with placental pathology is an important means of preventing massive blood loss and reducing the number of blood transfusions, as the first stage of the strategy “patient blood management”.Intravenous iron (III) sucrose complex hydroxide has demonstrated a high clinical efficacy in the treatment of iron deficiency anemia in pregnant women with placental pathology and can be recommended for widespread use in practical medicine.

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Cesarean Scar Pregnancy Successfully Managed to Term: When the Patient Is Determined to Keep the Pregnancy

Medicina ◽

10.3390/medicina56100496 ◽

2020 ◽

Vol 56 (10) ◽

pp. 496

Author(s):

Ranko Kutlesic ◽

Marija Kutlesic ◽

Predrag Vukomanovic ◽

Milan Stefanovic ◽

Danka Mostic-Stanisic

Keyword(s):

Early Diagnosis ◽

Cesarean Section ◽

Placenta Previa ◽

Expectant Management ◽

Severe Bleeding ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Uterine Incision ◽

Gestational Sac

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, defined as the implantation of the gestational sac at the uterine incision scar of the previous cesarean section. This condition is associated with severe maternal and fetal/neonatal complications, including severe bleeding, rupture of the uterus, fetal demise, or preterm delivery. In view of these, early diagnosis allows the option of termination of pregnancy. In this case report, we present a patient with a cesarean scar pregnancy who was diagnosed at the sixth week of gestation but declined early termination of the pregnancy and was managed to the 38th week. Placenta previa was confirmed in the second trimester. A planned cesarean section was performed that resulted in the birth of a live full-term neonate. Intraoperatively, placenta percreta was diagnosed, and due to uncontrollable bleeding, a hysterectomy was performed. The postoperative course was uneventful. In cases where an early diagnosis of CSP is made, women should be counseled that this will almost certainly evolve to placenta previa, and the associated risks should be explained. Close follow-up of CSP is mandatory if expectant management is selected. Further studies are needed for definitive conclusions and to determine the risks of expectant management.

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Controversies in the Clinical Practice of Patient Blood Management

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2020.11.020 ◽

2020 ◽

Author(s):

Daniel Bolliger ◽

Joachim M. Erb ◽

Andreas Buser

Keyword(s):

Clinical Practice ◽

Patient Blood Management ◽

Blood Management

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Patient Blood Management in der Orthopädie und Unfallchirurgie

Orthopädie und Unfallchirurgie up2date ◽

10.1055/a-0945-2550 ◽

2020 ◽

Vol 15 (03) ◽

pp. 239-255

Author(s):

Lea Valeska Blum ◽

Hendrik Kohlhof ◽

Dieter Wirtz ◽

Kai Zacharowski ◽

Patrick Meybohm

Keyword(s):

Patient Blood Management ◽

Blood Management ◽

Orthopädie Und Unfallchirurgie

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A Case of Emergency Cesarean Section on Client with Pseudopregnancy

10.32592/zamen.2020.1.1.100 ◽

2020 ◽

pp. 1-6

Keyword(s):

Heart Rate ◽

Cesarean Section ◽

Fetal Heart Rate ◽

Medical Service ◽

Fetal Heart ◽

Placenta Previa ◽

Urban Hospital ◽

Emergency Cesarean Section ◽

Emergency Cesarean ◽

Rural Health Center

Pseudopregnancy detection is significant while as the false pregnancy may show all symptoms. It is important to differentiate it. This is a case report of a pseudopregnancy which led to an emergency cesarean section. A 28-year-old woman who claimed to 7-month pregnancy was brought to the rural health center by husband families complaining of vaginal bleeding. The woman refers to an urban hospital by Emergency Medical Service with the diagnosis of placenta previa. In the hospital, she underwent an emergency cesarean section due to a severe deceleration of fetal heart rate, prior to assessing by sonography. No fetus or signs of uterine or abdominal pregnancy were found. Wrong auscultation of the mother's heart rate instead of fetal heart rate seems to be the main error. It is required to pay more attention to the methods of differentiation of fetal heart rate from the mother's heart rate. This report enlightens false pregnancy and early differentiation.

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