scholarly journals Uterine Healing after Therapeutic Intrauterine Administration of TachoSil (Hemostatic Fleece) in Cesarean Section with Postpartum Hemorrhage Caused by Placenta Previa

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Katrine Fuglsang ◽  
Margit Dueholm ◽  
Estrid Stæhr-Hansen ◽  
Lone Kjeld Petersen
Keyword(s):  
Cesarean Section ◽  
Postpartum Haemorrhage ◽  
Placenta Previa ◽  
Post Partum ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Intrauterine Adhesions ◽  
Traditional Treatment ◽  
Reproductive Capability ◽  
Scar Healing

Background. Application of hemostatic fleece (TachoSil) directly onto the bleeding surfaces of the lower uterine segment has been used to obtain hemostasis during cesarean section caused by placenta previa.Methods. Eleven of 15 patients treated with TachoSil for excessive postpartum haemorrhage due to placenta previa were enrolled. An evaluation of the cesarean section scar by transvaginal ultrasound, the uterine cavity and endometrium by hysteroscopy, and the endometrium by biopsy were made. The main outcome measures were intrauterine adhesions, recovery of endometrium at the site of TachoSil application, visible remnants of TachoSil, and scar healing.Results. Eight patients had small remnants of TachoSil in the uterine cavity together with signs of resorption. All had a normal endometrial mucosa, and none had adhesions in the uterine cavity. All cesarean section scars were healed without defects.Conclusion. TachoSil did not seem to impair healing of the endometrium or scar formation in the uterus after intrauterine application. Resorption of TachoSil seems to progress individually. Intrauterine treatment with TachoSil is a valuable supplement to the traditional treatment of post partum haemorrhage and may help retain reproductive capability. This is a small study, and it will require more studies to confirm the reproducibility.

Balloon tamponade during cesarean section is useful for severe post-partum hemorrhage due to placenta previa

2011 ◽  
Vol 38 (1) ◽  
pp. 102-107 ◽  
Author(s):  
Takako Ishii ◽  
Kenjiro Sawada ◽  
Shunsuke Koyama ◽  
Aki Isobe ◽  
Atsuko Wakabayashi ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Placenta Previa ◽  
Post Partum ◽  
Post Partum Hemorrhage ◽  
Balloon Tamponade

scholarly journals Hysteroscopy to identify retained placental tissue and excision in secondary post-partum haemorrhage

2020 ◽  
Vol 9 (5) ◽  
pp. 1847
Author(s):  
Pratibha Devabhaktuni ◽  
Padmaja Allani
Keyword(s):  
Caesarean Delivery ◽  
Postpartum Haemorrhage ◽  
Post Partum ◽  
Uterine Fibroids ◽  
Uterine Cavity ◽  
Placental Tissue ◽  
Complete Removal ◽  
Time Treatment ◽  
Products Of Conception ◽  
Retained Placental Tissue

Background: Most cases of secondary postpartum haemorrhage (PPH) are due to retained placental products (RPP). This study had a crop of five cases of secondary PPH, referral cases, during a period of six months during 2006. Four cases were following a caesarean delivery and in one, sub mucous and intra mural, uterine fibroids, caused retained placental tissue by distortion of the uterine cavity. Objectives of this study were to evaluate the feasibility of hysteroscopy to identify the retained placental products in cases of secondary postpartum haemorrhage. Verification of complete removal of RPP by reinsertion of hysteroscope, after removal of RPP by using a sponge holder, or curette.Methods: Trans vaginal ultrasonography (TVS) identified echogenic retained products of conception in all cases. Surgical profile investigations were done as per protocol. Transfusion of blood products was needed in some. Bettocchi 5 mm continuous flow hysteroscope (Karl Storz) was used. Storz endomat hysteroflator was used for irrigation and aspiration.Results: Hysteroscopic guided excision of the placental tissue was one-time treatment in four of study cases, and one needed a second hysteroscopic excision. Secondary PPH occurred at varying periods after the caesarean delivery, one week in one, two weeks in one case, three weeks in two cases and one woman was admitted with retained placenta, primary PPH continuing to secondary PPH. Hysteroscopy done during the puerperal period, in cases of secondary PPH, had certain challenges to cope with.Conclusions: Hysteroscopic guided excision of the retained placental tissue was successful in all the five cases with secondary postpartum haemorrhage. Hysteroscopy is an excellent procedure in cases of secondary PPH. We request guidelines committees to consider including hysteroscopic guided removal of retained placental products, in the algorithm of management of secondary PPH.

Evaluation of uterine scar healing by transvaginal ultrasound in 607 nonpregnant women with a history of cesarean section

2020 ◽  
Author(s):  
Xingchen Zhou ◽  
Tao Zhang ◽  
Huayuan Qiao ◽  
Yi Zhang ◽  
Xipeng Wang
Keyword(s):  
Cesarean Section ◽  
Clinical Symptoms ◽  
Transvaginal Ultrasound ◽  
Cesarean Scar ◽  
Female Reproductive Health ◽  
Position Detection ◽  
The Difference ◽  
Uterine Scar ◽  
Group B ◽  
Scar Healing

Abstract Background: Caesarean scar defect (CSD) seriously affects female reproductive health. In this study, we aim to evaluate uterine scar healing by transvaginal ultrasound（TVS）in nonpregnant women with cesarean section（CS）history and to build a predictive model for cesarean section defects is very necessary. Methods: A total of 607 nonpregnant women with previous CS who have transvaginal ultrasound measurements of the thickness of the lower uterine segment . The related clinical data were recorded and analyzed. Results: All patients were divided into two groups according to their clinical symptoms: Group A (N=405) who had no cesarean scar symptoms, and Group B (N=141) who had cesarean scar symptoms. The difference in frequency of CS, uterine position, detection rate of CSD and the the residual muscular layer (TRM) of the CSD were statistically significant between groups; the TRM measurements of the two groups were (mm) 5.39±3.34 vs 3.22±2.33, P<0.05.All patients were divided into two groups according to whether they had CSDs: Group C (N=337) who had no CSDs , Group D (N=209) who had CSDs on ultrasound examination. The differences in frequency of CS, uterine position, TRM between groups were statistically significant (P<0.05). In the model predicting CSDs by TRM with TVS, the area under the ROC curve was 0.771, the cut-off value was 4.15 mm. The sensitivity and specificity were 87.8% and 71.3%,respectively.Conclusions: Patients with no clinical symptoms had a mean TRM on transvaginal ultrasonography of 5.39 ± 3.34 mm, which could be used as a good reference to predict the recovery of patients with CSDs after repair surgery.

Successful treatment of placenta previa totalis using the combination of a two-stage cesarean operation and uterine arteries embolization in a hybrid operating room

2016 ◽  
Vol 5 (1) ◽  
pp. 31-34
Author(s):  
Maya Koyano ◽  
Junichi Hasegawa ◽  
Tatsuya Arakaki ◽  
Ryu Matsuoka ◽  
Akihiko Sekizawa
Keyword(s):  
Cesarean Section ◽  
Operating Room ◽  
Placenta Previa ◽  
Transvaginal Ultrasound ◽  
Arterial Embolization ◽  
Lower Uterine Segment ◽  
Hybrid Operating Room ◽  
Operation Room ◽  
Hybrid Operation ◽  
Emergency Cesarean

Abstract A 37-year-old primigravida female with placenta previa totalis was transferred to our hospital at 29 weeks of gestation. A transvaginal ultrasound examination showed a dropped placenta into the uterine cervix and an effaced lower uterine segment. The boundary between the cervical muscle layer and the placenta was unclear. Consequently, although it was unclear whether complication of the adherence of placenta was present or not, massive hemorrhage with atonic bleeding in the lower uterine segment after placenta removal was strongly suspected. As the patient had uncontrolled vaginal bleeding, an emergency cesarean section was performed in a hybrid operating room. A transverse fundal incision of the uterus was made, and a 1143 g healthy neonate was delivered. As no signs of placental detachment or persistent bleeding were found, the uterus was closed, leaving the placenta. Thereafter bilateral uterine arterial embolization (UAE) with absorbable gelatin sponges was performed. On the third day after the operation, a second operation for placental removal. The placenta detached smoothly, but compression sutures were placed to control the bleeding at the site of placental removal around the uterine isthmus. In this case, we were able to conduct the treatment smoothly because of the antenatal ultrasound assessment and precise preparation of the cesarean section with UAE in the hybrid operation room. Using the hybrid operation room, sharing detailed surgical planning in cooperation with the physicians from other departments is important for obtaining a good outcome.

scholarly journals Intrauterine Gauze Packing in Primary Post Partum Hemorrhage following Caesarean section: A Clinical study

2013 ◽  
Vol 7 (1) ◽  
pp. 33-36
Author(s):  
Shao Yong ◽  
M Pradhan
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Placenta Previa ◽  
Post Partum ◽  
Cost Effective ◽  
Invasive Technique ◽  
Safe Procedure ◽  
Post Partum Hemorrhage ◽  
Gauze Packing ◽  
A Prospective Study

Aims: To study the effectiveness of uterine gauze packing to manage and prevent primary postpartum haemorrhage during cesarean delivery. Methods: This was a prospective study that was conducted in the department of obstetrics and gynecology, first affiliated hospital of Chongqing Medical University from Jan to May 2011. Patients included in the study were those with intractable postpartum hemorrhage not responding to medical treatment and for prevention of hemorrhage that could develop during cesarean section. Exclusion criteria included cases of ruptured uterus and vaginal deliveries.Packing was done using 2 m long and 10 cm wide sterilized gauze from the fundus through the cesarean incision with its end passing through cervix into the vagina and left for 24-48 hours or removed earlier in cases of failure to control hemorrhage. Results: Intrauterine gauze packing during cesarean section to arrest primary postpartum hamorrhage is a successful non-invasive technique. Intractable primary postpartum hamorrhage encountered in 42 (30.9%) cases had PPH after cesarean section. Placenta previa found in 48 (35.3%) cases unresponsive to uterotonics drugs was the commonest cause of uterine gauze packing. Intrauterine gauze packing was successful in 130 (95.6%) cases. Conclusions: Uterine packing is a cost effective, quick and safe procedure to manage and prevent primary PPH during cesarean delivery. Uterine packing is of benefit in achieving hemostasis particularly in cases of post partum hemorrhage due to low-lying placenta previa/accreta associated with lower segment bleeding conserving the uterus in women with cesarean delivery. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 33-36 DOI: http://dx.doi.org/10.3126/njog.v7i1.8833

scholarly journals Emergency obstetric hysterectomy: experience at a tertiary care centre in Central India

2019 ◽  
Vol 8 (8) ◽  
pp. 3280
Author(s):  
Jayashree Mulik ◽  
Tanvi Vibhute
Keyword(s):  
Cesarean Section ◽  
Uterine Rupture ◽  
Placenta Previa ◽  
Post Partum ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Central India ◽  
Tertiary Care Centre ◽  
Study Centre ◽  
Labour Room

Background: Obstetric hysterectomy is an important procedure in modern obstetrics and its proper indications, risks and complications need to be studied for judicious usage and improvement in outcome.Methods: A retrospective, record-based study was carried out over one and a half years at a tertiary care government hospital. All the patients who underwent emergency obstetric hysterectomy at the study centre during study period were studied. Labour room register, operation room register for emergency and elective cases, case records, referral slips and mortality register data were reviewed for the same and outcomes analysed.Results: Total 33 patients underwent emergency obstetric hysterectomy, with the incidence observed at 0.21%. The most common indications were atonic post-partum hemorrhage (42.4%), uterine rupture (33.3%) and morbidly adherent placenta (18.1%). Prior cesarean section (36.4%) and placenta previa (15.1%) were the commonest predisposing factors associated with PPH and uterine rupture. Subtotal hysterectomy (66.7%) was observed to be the preferred type of surgery. Out of total 7 maternal deaths that occurred, 4 (57%) were because of disseminated intravascular coagulation.Conclusions: There is increasing trend in the rate of obstetric hysterectomy along with rise in rate of previous LSCS, emphasizing the importance of the mode of delivery. Measures to reduce the rate of primary cesarean section are advisable.

scholarly journals Evacuation of embryo in the presence of intrauterine adhesions

2016 ◽  
Vol 97 (6) ◽  
pp. 967-970
Author(s):  
R I Gabidullina ◽  
S E Savel’ev ◽  
N A Gabitov ◽  
O N Mikhaylova ◽  
L I Sirmatova ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Uterine Cavity ◽  
Treatment Method ◽  
Postnatal Period ◽  
Gravid Uterus ◽  
Premature Labor ◽  
Menstrual Disorders ◽  
Intrauterine Adhesions ◽  
Controversial Topic

Asherman syndrome is a controversial topic in gynecology without a clear consensus for treatment. This pathology is characterized by adhesions in the uterine cavity. The main cause of this disorder is injuries to the gravid uterus especially in abortion, during postnatal period or after missed miscarriage. Menstrual disorders and infertility are characteristic clinical features of Asherman syndrome. Pregnancy may be complicated with premature labor, placenta previa and placenta accreta. Introduction of hysteroscopy has changed diagnosis and management of intrauterine synechiae and it is therefore considered the most valuable tool nowadays. Preferred treatment method is hysteroscopic lysis of adhesions combined with estrogens. A clinical case of asymptomatic Asherman syndrome in a 29 year old female is presented in the article. Bipolar hysteroscopic resection of synechiae in combination with curettage was proved to be an effective and safe method of treatment.

scholarly journals A Case of Placenta Increta Mimicking Submucous Leiomyoma

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Ali Ekiz ◽  
Ibrahim Polat ◽  
Sezcan Mumusoglu ◽  
Burchan Aydiner ◽  
Cagdas Ozdemir ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Postpartum Hemorrhage ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Uterine Cavity ◽  
Final Diagnosis ◽  
Curative Treatment ◽  
Pathological Examination ◽  
Placenta Increta ◽  
Early Postpartum

In recent years with the increase in cesarean section rates, the frequency of placenta accreta cases rises. It causes 33–50% of all emergency peripartum hysterectomies. We present a 42-year-old case who was caught with early postpartum hemorrhage due to retained placental products. The ultrasonography showed a 65 × 84 mm mass in the uterine cavity after the delivery. Due to presence of early postpartum hemorrhage which needs transfusion, an intervention decision was made. The patient underwent curettage but the mass could not be removed so that placental retention was ruled out. Submucous leiomyoma was made as first-prediagnosis. Hysterectomy operation was performed as a curative treatment. Placenta increta diagnosis was made as a final diagnosis with pathological examination. As a result, placental attachment disorders may be overlooked if it is not a placenta previa case.

scholarly journals Isthmocele: an overview of diagnosis and treatment

2019 ◽  
Vol 65 (5) ◽  
pp. 714-721 ◽  
Author(s):  
Thaysa Guglieri Kremer ◽  
Isadora Bueloni Ghiorzi ◽  
Raquel Papandreus Dibi
Keyword(s):  
Cesarean Section ◽  
Surgical Management ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Cost Effective ◽  
Uterine Wall ◽  
Large Defect ◽  
Cesarean Scar ◽  
Incomplete Closure ◽  
Previous Cesarean

SUMMARY An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic pregnancy may also appear as complications of this condition. The risk factors of isthmocele proven to date include retroflexed uterus and multiple cesarean sections. Nevertheless, factors such as a lower position of cesarean section, incomplete closure of the hysterotomy, early adhesions of the uterine wall and a genetic predisposition may also contribute to the development of a niche. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele. However, transvaginal ultrasound and saline infusion sonohysterography emerge as specific, sensitive and cost-effective methods to diagnose isthmocele. The treatment includes clinical or surgical management, depending on the size of the defect, the presence of symptoms, the presence of secondary infertility and plans of childbearing. Surgical management includes minimally invasive approaches with sparing techniques such as hysteroscopic, laparoscopic or transvaginal procedures according to the defect size.

scholarly journals The Diagnosis and Management of Asherman’s Syndrome Developed after Cesarean Section and Reproductive Outcome

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Pinar Ozcan Cenksoy ◽  
Cem Ficicioglu ◽  
Mert Yesiladali ◽  
Ozge Kizilkale
Keyword(s):  
Cesarean Section ◽  
Healing Process ◽  
Basal Layer ◽  
Uterine Cavity ◽  
Intrauterine Adhesions ◽  
Asherman’S Syndrome ◽  
Diagnosis And Management ◽  
Elective Abortion ◽  
Incomplete Abortion ◽  
Menstrual Disturbances

Intrauterine adhesions (IUAs) frequently occur as a result of trauma to the basal layer of endometrium following pregnancy-related curettage such as incomplete abortion (33,3%), postpartum hemorrhage (37,5%), and elective abortion (8,3%). Hysterotomy, myomectomy, Cesarean section, hysteroscopic procedures, such as resection of submucosal leiomyomata or uterine septae, and endometrial ablation are less common etiologic factors resulting in IUA formation. Patients with Asherman’s syndrome usually present with menstrual disturbances, infertility, or recurrent pregnancy loss. A successful treatment of infertility could be achieved by restoration of the uterine cavity, prevention of IUA reformation, and promotion of healing process. We presented the diagnosis and management of a case that suffers from menstrual disturbances and secondary infertility resulted from IUA formation developed after Cesarean section.

Sign in / Sign up

Export Citation Format

Share Document