Extra-abdominal removal of placenta during cesarean section: a prospective randomized controlled trial of a novel technique

2016 ◽  
Vol 44 (5) ◽  
Author(s):  
Baris Kaya ◽  
Onur Guralp ◽  
Korkut Daglar ◽  
Abdullah Tuten ◽  
Aygul Demirol ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Cesarean Section ◽  
Controlled Trial ◽  
Abdominal Cavity ◽  
Length Of Hospital Stay ◽  
University Hospital ◽  
Estimated Blood Loss ◽  
Delivery Technique ◽  
The Mean

AbstractTo evaluate intraoperative and early postoperative outcomes of a novel placenta delivery technique; extra-abdominal removal vs. intra-abdominal removal of the placenta during cesarean section (CS).A total of 210 women delivering by CS at term in a tertiary university hospital between March 2014 and January 2015 were randomized to extra-abdominal removal vs. intra-abdominal removal of the placenta. The women were randomly allocated to the extra- (group 1) or intra-abdominal removal group (group 2) according to random sampling method, where women with even and odd numbers were allocated to intra- and extra-abdominal groups, respectively. The amount of intra-abdominal hemorrhagic fluid accumulation, the duration of operation and estimated blood loss during operation were the primary outcomes. The secondary outcomes included the mean difference between pre- and post-operative hemoglobin and hematocrit levels, the mean postoperative pain score, any additional need of analgesia, postoperative bowel function, postoperative endometritis and wound infections.The amount of aspirated hemorrhagic fluid was significantly higher in the intra-abdominal group compared to the extra-abdominal group (34.6±22.2 mL vs. 9.4±4.8 mL, P<0.001). Mean duration of the operation, intraoperative blood loss, postoperative requirement of additional analgesia, postoperative pain scores, postoperative endometritis or wound infection, and length of hospital stay were not significantly different between the intra- and extra-abdominal placental removal groups.By extra-abdominal removal of the placenta, the accumulation of bloody fluid in the abdominal cavity is significantly less compared to the intra-abdominal removal method, which, in turn, provides avoidance of excessive mounted-gauze use, intra-abdominal manipulations, or iatrogenic trauma.

Management of intended durotomy in minimally invasive intradural spine surgery

2014 ◽  
Vol 21 (2) ◽  
pp. 279-285 ◽  
Author(s):  
Lee A. Tan ◽  
Ippei Takagi ◽  
David Straus ◽  
John E. O'Toole
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Length Of Hospital Stay ◽  
Bed Rest ◽  
Tubular Retractor ◽  
Specific Patient ◽  
Dural Closure ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Operative Notes

Object Minimally invasive surgery (MIS) has been increasingly used for the treatment of various intradural spinal pathologies in recent years. Although MIS techniques allow for successful treatment of intradural pathology, primary dural closure in MIS can be technically challenging due to a limited surgical corridor through the tubular retractor system. The authors describe their experience with 23 consecutive patients from a single institution who underwent MIS for intradural pathologies, along with a review of pertinent literature. Methods A retrospective review of a prospectively collected surgical database was performed to identify patients who underwent MIS for intradural spinal pathologies between November 2006 and July 2013. Patient demographics, preoperative records, operative notes, and postoperative records were reviewed. Primary outcomes include operative duration, estimated blood loss, length of bed rest, length of hospital stay, and postoperative complications, which were recorded prospectively. Results Twenty-three patients who had undergone MIS for intradural spinal pathologies during the study period were identified. Fifteen patients (65.2%) were female and 8 (34.8%) were male. The mean age at surgery was 54.4 years (range 30–74 years). Surgical pathologies included neoplastic (17 patients), congenital (3 patients), vascular (2 patients), and degenerative (1 patient). The most common spinal region treated was lumbar (11 patients), followed by thoracic (9 patients), cervical (2 patients), and sacral (1 patient). The mean operative time was 161.1 minutes, and the mean estimated blood loss was 107.2 ml. All patients were allowed full activity less than 24 hours after surgery. The median length of stay was 78.2 hours. Primary sutured dural closure was achieved using specialized MIS instruments with adjuvant fibrin sealant in all cases. The rate of postoperative headache, nausea, vomiting, and diplopia was 0%. No case of cutaneous CSF fistula or symptomatic pseudomeningocele was identified at follow-up, and no patient required revision surgery. Conclusions Primary dural closure with early mobilization is an effective strategy with excellent clinical outcomes in the use of MIS techniques for intradural spinal pathology. Prolonged bed rest after successful primary dural closure appears unnecessary, and the need for watertight dural closure should not prevent the use of MIS techniques in this specific patient population.

scholarly journals One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care

2017 ◽  
Vol 20 (5) ◽  
pp. 410-418 ◽  
Author(s):  
Dennis C. Nguyen ◽  
Scott J. Farber ◽  
Gary B. Skolnick ◽  
Sybill D. Naidoo ◽  
Matthew D. Smyth ◽  
...  
Keyword(s):  
Blood Loss ◽  
Patient Care ◽  
Length Of Hospital Stay ◽  
Successful Outcome ◽  
Emissary Vein ◽  
Sagittal Craniosynostosis ◽  
Care Protocol ◽  
Estimated Blood Loss ◽  
Helmet Therapy ◽  
The Mean

OBJECTIVEEndoscope-assisted repair of sagittal craniosynostosis was adopted at St. Louis Children’s Hospital in 2006. This study examines the first 100 cases and reviews the outcomes and evolution of patient care protocols at our institution.METHODSThe authors performed a retrospective chart review of the first 100 consecutive endoscopic repairs of sagittal craniosynostosis between 2006 and 2014. The data associated with length of hospital stay, blood loss, transfusion rates, operative times, cephalic indices (CIs), complications, and cranial remolding orthosis were reviewed. Measurements were taken from available preoperative and 1-year postoperative 3D reconstructed CT scans.RESULTSThe patients’ mean age at surgery was 3.3 ± 1.1 months. Of the 100 patients, 30 were female and 70 were male. The following perioperative data were noted. The mean operative time (± SD) was 77.1 ± 22.2 minutes, the mean estimated blood loss was 34.0 ± 34.8 ml, and the mean length of stay was 1.1 ± 0.4 days; 9% of patients required transfusions; and the mean pre- and postoperative CI values were 69.1 ± 3.8 and 77.7 ± 4.2, respectively. Conversion to open technique was required in 1 case due to presence of a large emissary vein that was difficult to control endoscopically. The mean duration of helmet therapy was 8.0 ± 2.9 months. Parietal osteotomies were eventually excluded from the procedure.CONCLUSIONSThe clinical outcomes and improvements in CI seen in our population are similar to those seen at other high-volume centers. Since the inception of endoscope-assisted repair at our institution, the patient care protocol has undergone several significant changes. We have been able to remove less cranium using our “narrow-vertex” suturectomy technique without affecting patient safety or outcome. Patient compliance with helmet therapy and collaborative care with the orthotists remain the most essential aspects of a successful outcome.

scholarly journals Tranexamic acid in prevention of postpartum hemorrhage in elective cesarean section

2019 ◽  
Vol 8 (2) ◽  
pp. 372
Author(s):  
Pravin Shah ◽  
Ajay Agrawal ◽  
Shailaja Chhetri ◽  
Pappu Rijal ◽  
Nisha K. Bhatta
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Elective Cesarean Section ◽  
Controlled Study ◽  
Control Group ◽  
Estimated Blood Loss ◽  
Elective Cesarean ◽  
The Mean

Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.

scholarly journals Thoracoabdominal Approach for Large Retroperitoneal Masses: Case Series and Review

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Siv Venkat ◽  
Andre Matteliano ◽  
Darrel Drachenberg
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Blood Loss ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Postoperative Course ◽  
Advantages And Disadvantages ◽  
Estimated Blood Loss ◽  
Thoracoabdominal Approach ◽  
Thoracoabdominal Incision

The thoracoabdominal incision was first described in 1946 as an approach to concomitant abdominal, retroperitoneal, and thoracic injuries. In urology, this technique was popularized in 1949 for the resection of large renal tumours. Today, it is reserved for complex cases where optimal exposure of the renal hilum and adrenal and superior pole of the kidney is necessary. We present four consecutive cases in which this approach was taken by a single surgeon at our tertiary surgical centre. The outcomes, postoperative course, and pathology are described. We provide a comprehensive literature review and outline the indications, advantages, and disadvantages of this approach. Objectives. To present a case series outlining the efficacy and safety of the thoracoabdominal incision in complex oncologic procedures in urology. Methods. Four cases utilizing the thoracoabdominal incision, performed by a single surgeon at our tertiary care center, were reviewed. Case history, preoperative imaging, intraoperative experience, postoperative course, final pathology, and complications were examined. A thorough literature review was performed and comparison made with historical cohorts for estimated blood loss, length of stay, and complications encountered versus other common surgical approaches. The indications, advantages, and disadvantages of the thoracoabdominal approach were outlined. Results. All patients had large retroperitoneal masses of varying complexity, requiring maximal surgical exposure. Surgery was straightforward in all cases, without any significant perioperative or postoperative complications. Postoperative pain, length of hospital stay, estimated blood loss, and analgesia requirements were all similar to open and mini-flank approaches in review of historical case series cohorts. Laparoscopic approaches had lower estimated blood loss and length of stay. Conclusions. The thoracoabdominal approach is rarely utilized in urological surgery, due to the perceived morbidity in violating the thoracic cavity. These cases outline the benefit of the thoracoabdominal approach in select cases requiring maximal surgical exposure, and the generally benign postoperative course that appropriately selected patients may hope to endure. Postoperative pain, length of hospital stay, estimated blood loss, and analgesia requirements can be expected to be similar open and mini-flank approaches. As expected, laparoscopic approaches had lower estimated blood loss and length of stay.

scholarly journals Comparison of Perioperative Outcomes of Total Laparoscopic and Robotically Assisted Hysterectomy for Benign Pathology during Introduction of a Robotic Program

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Gokhan Sami Kilic ◽  
Gradie Moore ◽  
Ayman Elbatanony ◽  
Carmen Radecki ◽  
John Y. Phelps ◽  
...  
Keyword(s):  
Blood Loss ◽  
Laparoscopic Hysterectomy ◽  
Vaginal Surgery ◽  
University Hospital ◽  
Perioperative Outcomes ◽  
Study Objective ◽  
Invasive Approach ◽  
Benign Pathology ◽  
Estimated Blood Loss ◽  
The Mean

Study Objective. Prospectively compare outcomes of robotically assisted and laparoscopic hysterectomy in the process of implementing a new robotic program.Design. Prospectively comparative observational nonrandomized study.Design Classification. II-1.Setting. Tertiary caregiver university hospital.Patients. Data collected consecutively 24 months, 34 patients underwent laparoscopic hysterectomy, 25 patients underwent robotic hysterectomy, and 11 patients underwent vaginal hysterectomy at our institution.Interventions. Outcomes of robotically assisted, laparoscopic, and vaginal complex hysterectomies performed by a single surgeon for noncancerous indications.Measurements and Main Results. Operative times were minutes for laparoscopic, minutes for robotic, and minutes for vaginal (). Estimated blood loss for patients undergoing laparoscopic surgery was  cc,  cc for robotic surgery, and  cc for vaginal surgery (). The mean length of stay ranged from 1.8 to 2.3 days for the 3 methods. Association was significant for uterine weight () among surgery methods.Conclusion. Robotically assisted hysterectomy is feasible with low morbidity, a shorter hospital stay, and less blood loss. This suggests that robotic assistance facilitates a minimally invasive approach for patients with larger uterine size even during implementing a new robotic program.

scholarly journals Laparoskopska resekcija jeter zaradi zasevkov raka debelega črevesa in danke – rezultati zdravljenja

2017 ◽  
Vol 86 (3-4) ◽  
Author(s):  
Arpad Ivanecz ◽  
Vid Pivec ◽  
Irena Plahuta ◽  
Bojan Krebs ◽  
Tomaž Jagrič ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Conversion Rate ◽  
Liver Tumors ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Secondary Outcome ◽  
Estimated Blood Loss ◽  
The Mean

Background: In many referral centers, laparoscopic liver resection (LLR) is a well-established method for the management of colorectal liver metastases (CLM). The aim of this study is to review a single institution experience.Methods: Between April 2008 and September 2016, 58 patients underwent LLR for various benign and malignant liver tumors. The analysis included 12 patients operated on for CLM. The primary outcomes of this prospective non-randomized study included operative procedure and operating time (minutes), estimated blood loss (mL), conversion rate, R0 resections, resection margins (mm), length of hospital stay (days), post-operative morbidity, and mortality. The secondary outcome of the study was survival analysis.Results: Eight patients (67 %) had atypical LLR. The average operating time was 130 minutes (range 60–210 minutes). The mean estimated blood loss was 140 mL (range < 50–600 mL). In one patient LLR was converted to open procedure (conversion rate 8 %). Seven patients (58 %) had one liver metastasis. The mean metastasis size was 3.6 cm (range 1–9 cm). R0 resection was achieved in all cases. The mean resection margin was 6.8 mm (range 2–15 mm). Te mean length of hospital stay was 6 days (range 3–12 days). Morbidity and mortality rates were 0 %. The median follow-up for surviving patients was 13 months. Nine patients are alive with no evidence of disease, two patients are alive with disease and one patient died of disease.Conclusion: LLR is a feasible and safe method for the treatment of CLM and there is no compromise of oncological surgical principles.

scholarly journals Comparison of Posterior Retroperitoneoscopic Adrenalectomy Versus Lateral Transperitoneal Laparoscopic Adrenalectomy for Adrenal Tumors: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Chunyang Meng ◽  
Chunxiao Du ◽  
Lei Peng ◽  
Jinze Li ◽  
Jinming Li ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Laparoscopic Adrenalectomy ◽  
Conversion Rate ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Adrenal Tumors ◽  
Retroperitoneoscopic Adrenalectomy ◽  
Estimated Blood Loss ◽  
Posterior Retroperitoneoscopic Adrenalectomy

ObjectiveTo discuss the differences in the effectiveness and security for adrenal tumors by posterior retroperitoneoscopic adrenalectomy (PRA) and lateral transperitoneal laparoscopic adrenalectomy (LTA).MethodsWe systematically searched PubMed, Embase, Scopus database and Cochrane Library, and the date was from above database establishment to November 2020. Stata 16 was used for calculation and statistical analyses.ResultsNine studies involving eight hundred patients were included. The following differences were observed in favor of PRA vs LTA: less operative time (MD: −22.5; 95% CI −32.57 to −12.45; P=0.000), Fewer estimated blood loss (MD: −15.17; 95% CI −26.63 to −3.72; P=0.009), lower intensity of postoperative pain (MD: −0.56; 95% CI, −1.05 to −0.07; P=0.026), shorter length of hospital stay (MD: −1.15; 95% CI −1.94 to −0.36; P=0.04). No differences were shown in conversion rate (OR 2.07; 95%CI 0.71 to 6.03; P=0.181) and complications (OR 0.85;95% CI 0.46 to 1.56; P=0.597).ConclusionsPosterior retroperitoneoscopic adrenalectomy was clinically superior to lateral transperitoneal laparoscopic adrenalectomy for adrenal tumors in operative time, estimated blood loss, length of hospital stay, and postoperative pain. Only in term of conversion rate and complications, both were similar

scholarly journals Use of the base purse-string suture approach to remove giant uterine fibroids during cesarean section

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051989386
Author(s):  
Dan Liu ◽  
Min Han ◽  
Pu Huang ◽  
Chunfang Li ◽  
Xuelan Li
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Uterine Fibroids ◽  
Uterine Wall ◽  
Purse String Suture ◽  
Purse String ◽  
Operative Duration ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Cesarean Myomectomy

Objective This study aimed to investigate the optimal strategy for myomectomy for removing giant uterine fibroids when necessary in women undergoing cesarean section. Methods This study was retrospective in design, and assessed outcomes in 26 patients who underwent myomectomy using a “base purse-string suture” during cesarean section. The operative duration, blood loss, uterine involution, and duration of postpartum lochia were analyzed. Results This suture was associated with a mean operative duration of 11.17 ± 5.36 minutes and the mean estimated blood loss was 11.15 ± 6.05 mL. The mean postpartum duration of lochia was 34.92 ± 7.55 days and there were no cases of postpartum hemorrhage. Uterine size returned to normal within 6 weeks of delivery, without any apparent defects or abnormalities in the uterine wall as shown by an ultrasonic examination. Conclusion This novel implementation of a base purse-string suture during cesarean myomectomy for removal of giant fibroids is a simple, safe, and effective intervention that should be considered for implementation in appropriate patients.

scholarly journals Post-Operative Drop in Hemoglobin and Need of Blood Transfusion in Cesarean Section at Dhulikhel Hospital, Kathmandu University Hospital

2015 ◽  
Vol 11 (2) ◽  
pp. 144-146 ◽  
Author(s):  
B Singh ◽  
N Adhikari ◽  
S Ghimire ◽  
S Dhital
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Cesarean Section ◽  
Emergency Situation ◽  
University Hospital ◽  
Uterine Incision ◽  
Emergency Cesarean ◽  
Estimated Blood Loss ◽  
Transfusion Ratio ◽  
Cross Match

Background Cesarean section has been identified as one of the commonest indication for blood transfusion in obstetric practice because it involves risk of major intra-operative blood loss. Different figures varying from less than 500 ml to more than 1000 ml have been quoted as estimated blood loss associated with caesarean section. There is also a wide variation in blood ordering practices for this surgery. Objective The objective of this study is to evaluate the blood ordering practice and transfusion for cesarean sections at our institute, to see post-operative drop in hemoglobin and hematocrit and to correlate those parameters with the duration between uterine incision and repair. Methods In this prospective observational study, non-randomised purposive sample was taken from 121 ladies who underwent elective and emergency cesarean section at the department of obstetrics of Dhulikhel Hospital-Kathmandu University Hospital. Post-cesarean drop in hemoglobin and hematocrit and their relation with duration of uterine manipulation was calculated. Cross-match to transfusion (C/T ratio) ratio, transfusion probability (%T) and transfusion index (Ti) were also calculated. Results Most frequent blood group was found to be O positive (38%) among those ladies. Average post-cesarean drop in hemoglobin was 1.52±1.27 gm/dl and drop in haematocrit was 5.49±4.1%. Post-operative drop in hemoglobin and haematocrit had weak and positive linear relation with duration between uterine incision and repair. Cross-match to transfusion ratio was 1, transfusion probability 100% and transfusion index was 2. Conclusion There is no need of routine cross-matching of blood for cesarean section. Only grouping with confirmation of availability should be done for emergency situation. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12490 Kathmandu University Medical Journal Vol.11(2) 2013: 144-146

scholarly journals A COMPARISON OF THE EFFECTIVENESS OF SUBLINGUAL MISOPROSTOL VERSUS INTRAVENOUS OXYTOCIN INFUSION IN REDUCING BLOOD LOSS IN FIRST TWO HOURS AT CAESAREAN SECTION

2021 ◽  
Vol 31 (03) ◽  
pp. 132-137
Author(s):  
Mahham Janjua ◽  
Maria Imran
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Controlled Trial ◽  
Elective Cesarean Section ◽  
Postoperative Blood Loss ◽  
Singleton Pregnancy ◽  
Estimated Blood Loss ◽  
Sublingual Misoprostol ◽  
Oxytocin Infusion ◽  
Misoprostol Group

OBJECTIVE The objective of the study was to compare the effectiveness of sublingual misoprostol in reducing intraoperative and postoperative blood loss with that of intravenous (IV) oxytocin infusion in the first two hours at cesarean delivery. STUDY DESIGN Randomized controlled trial PLACE AND DURATION OF STUDY The study was conducted in Lady Aitchison Hospital, Lahore unit IV-King Edward Medical University, and the duration of the study was one year. MATERIALS and METHODS Eighty-two women with term singleton pregnancy undergone elective cesarean section under spinal anesthesia were randomly allocated to receive either misoprostol 400 µg sublingually or  IV infusion of 20 units oxytocin in 1000ml of normal saline soon after delivery of the baby. Estimated blood loss at the surgery and within the first 2 h post-operation were measured in both groups. Side effects in both groups were also recorded. RESULTS Mean blood loss with misoprostol was significantly less as compared to that of oxytocin. Post-operative hemoglobin was decreased by -4.95% in sublingual misoprostol and in the oxytocin group it was decreased by -9.33%. Blood transfusion and additional uterotonic therapy were significantly higher in the oxytocin group as compared to that of misoprostol. Nausea, vomiting, and hypotension was significantly higher in oxytocin group as compared to that of the misoprostol group. On the other hand, pyrexia and shivering were significantly higher in the misoprostol group. CONCLUSION The results of this trial showed that sublingual misoprostol is more effective as compared to intravenous oxytocin infusion in terms of reduction of blood loss in the first two hours at the cesarean section. It offers several advantages over oxytocin including long shelf life, stability at room temperature, and oral administration which makes it a suitable uterotonic agent in low-resource areas.

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