Adjunctive intrauterine Foley’s Catheter Balloon adding to hypogastric artery ligation in the conservative management of morbid adherent placenta previa

Background: Objective of present study was to demonstrate the efficacy of Foley’s catheters balloon tamponade as an adjuvant to control blood loss during and after a caesarian section in patient undergone hypogastric artery ligation (HAL) due to morbid adherent placenta previa (MAPP).Methods: A single-center retrospective case-control clinical trial was carried out in a tertiary university hospital between March 2015 and March 2018, 124 women were undergoing cesarean delivery for MAPP, were managed conservatively either with HAL or HAL plus inflated Intrauterine Foley’s Catheter Balloon to control post-partum hemorrhage secondary to MAPP. In the case of conservative treatment protocol failure, cesarean hysterectomy was performed.Results: 124 women were enrolled (n=62 in each group). group of women received HAL plus Intrauterine Foley’s Catheter Balloon (group II)) showed a significant reduction in intraoperative and 4 hours post-operative blood loss compared with (Group I) which received HAL without Intrauterine Foley’s Catheter Balloon. (P = 0.0001,0.0.015), so the overall estimated blood loss in group II showed significant reduction compared with group I (P = 0.0001).Conclusions: Adjunctive intrauterine Foley's catheter balloon adding to HAL ligation in the management of MAPP is a novel combination approach have proved to be effective to control of intraoperative and PPH and to preserve the uterus as possible and change in the concept of MAPP management always mandates hysterectomy. And may become an alternative valid option to planned cesarean-hysterectomy in well-selected cases who have a strong desire for future fertility.

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Outcome of Transient Hypogastric Artery Balloon Occlusion with Cesarean Hysterectomy in Abnormal Adherent Placenta: Case Series

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.201963 ◽

2019 ◽

Author(s):

Keerati Hongsakul ◽

Jitwadee Suwanlee ◽

Sorracha Rookkapan ◽

Kittipitch Bannangkoon ◽

Ninlapa Pruksanusak ◽

...

Keyword(s):

Blood Loss ◽

Pregnant Women ◽

Case Series ◽

Balloon Occlusion ◽

Hypogastric Artery ◽

Abnormal Placentation ◽

Cesarean Hysterectomy ◽

Adherent Placenta ◽

Small Branch ◽

Estimated Blood Loss

Objective: To evaluate the outcome of pregnant women with abnormal placentation who underwent transient hypogastric artery balloon occlusion with cesarean hysterectomy.Material and Methods: Descriptive retrospective study of patients with abnormal adherent placenta who underwent transient hypogastric artery balloon occlusion with cesarean hysterectomy between January 2014 and December 2016. Data were recorded and analyzed.Results: Fourteen pregnant women with abnormal placentation were included in our series. Most patients underwent cesarean hysterectomy at less than 37 weeks of gestational age. The sonograms of 7 cases overestimated the severity of placenta adherence compared with the pathological diagnosis. The median estimated blood loss was 4,350 milliliters (mL). The median estimated blood loss in placenta accrete, increta and percreta were 3,000 mL, 5,337 mL and 5,150 mL, respectively. One case had a procedure-related complication: perforation of the small branch of the anterior division of the right hypogastric artery from the guidewire.Conclusion: Intraoperative transient balloon occlusion of the hypogastric arteries was an effective method and safe treatment for controlling the massive intraoperative bleeding of cesarean hysterectomy. This technique can be an alternative option in combination with surgery in cases of abnormal placental adherence.

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Prophylactic Hypogastric Artery Ligation during Placenta Percreta Surgery: A Retrospective Cohort Study

American Journal of Perinatology Reports ◽

10.1055/s-0038-1666793 ◽

2018 ◽

Vol 08 (02) ◽

pp. e142-e145

Author(s):

Theresa Kuhn ◽

Kristina Martimucci ◽

Abdulla Al-Khan ◽

Robyn Bilinski ◽

Stacy Zamudio ◽

...

Keyword(s):

Blood Loss ◽

Retrospective Cohort ◽

Placenta Percreta ◽

Control Group ◽

Study Group ◽

Distributed Data ◽

Hypogastric Artery ◽

Blood Products ◽

Artery Ligation ◽

Cesarean Hysterectomy

Objective To evaluate if prophylactic hypogastric artery ligation (HAL) decreases surgical blood loss and blood products transfused. Study Design This is a retrospective cohort study comparing patients with placenta percreta undergoing prophylactic HAL at the time of cesarean hysterectomy versus those who did not. Data were presented as means ± standard deviations, proportions, or medians with interquartile ranges. Demographic and clinical data were compared in the groups using Student's t-test for normally distributed data or the Mann–Whitney U test for nonnormally distributed data. Fisher's exact test was used for proportions and categorical variables. Data are reported as significant where p was <0.05. Results There were 26 patients included in the control group with no HAL and 11 patients included in the study group. Estimated blood loss for the study group was 1,000 mL versus 800 mL in the control. Units of PRCBs transfused were 4.5 units in the study group versus 2 units for the control group. None of these measures were found to be statistically significant. Conclusion Our data suggest there was no benefit in the use of prophylactic HAL in decreasing surgical blood loss or amount of blood products transfused in patients who had a cesarean hysterectomy performed for placenta percreta. Précis Prophylactic HAL does not decrease blood loss during surgery for placenta percreta.

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Acute hypervolemic hemodilution combined with controlled hypotension to minimize blood loss during operations of spine fusion: remifentanil versus magnesium sulfate

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00165-3 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Khaled Mohammed Elnaghy ◽

Ibrahimabd-Elsalam Nasr ◽

Eman Mohamed Kamal

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Magnesium Sulfate ◽

Spine Fusion ◽

Controlled Hypotension ◽

Group Iii ◽

Group I ◽

Estimated Blood Loss ◽

Hypervolemic Hemodilution ◽

Group Ii

Abstract Background Blood loss is one of the major problems during operations of spine fusion. Several blood-conservative measures were applied to reduce the incidence of blood loss—among them, acute hypervolemic hemodilution (AHH) and controlled hypotension (CH). This study was designed to detect the effect of combination of AHH with CH induced by remifentanil versus magnesium sulfate on the volume of blood loss, allogeneic blood transfusion, hemodynamics, coagulation, and electrolytes during operations for spine fusion which are risky operations with high incidence of blood loss and blood transfusion. Sixty patients scheduled for posterior fusion of the spine were randomly allocated into three groups of 20 patients each (group I (AHH), group II (AHH combined with remifentanil-based CH), and group III (AHH combined with magnesium sulfate-based CH)). Estimated blood loss and total volume of packed red blood cells (PRBCS) transfused were recorded. Arterial blood pressure (ABP) and heart rate (HR) measures were recorded. Blood samples were obtained for the detection of hemoglobin (Hb) and hematocrit (HCT). Results Estimated blood loss, percentage blood loss, and intraoperative RBC transfusion units were significantly high in group I in relation to group II and group III (Table 2). Cardiac output was significantly higher in group I in relation to group II and group III at 10, 15, 30, 45, and 60 min after start of AHH. MBP and HR results were significantly high in group I in comparison with group II and group III at 30, 45, 60, and 90 min and 2 and 3 h after start of study drugs. CVP results were significantly high in group I in relation to group II and group III at 15, 30, 45, 60, and 90 min after start of AHH. PTT was significantly increased in the three study groups in comparison with baseline inside each group after AHH. Conclusion Combination of AHH with CH induced by remifentanil or magnesium sulfate was associated with reduction in estimated blood loss, and total volume of PRBCS transfused. There was no significant difference between hemodynamic parameters with the use of remifentanil or magnesium sulfate except that SBP, DBP, and MBP results were significantly high with magnesium sulfate at 15 min after drug infusion. There was significant increase in PT and PTT after AHH that was not reflected by significant blood oozing from the operative field, or by difficulty in hemostasis.

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OPTIMIZATION OF OPERATIVE DELIVERY OF WOMEN IN LABOR WITH PLACENTA PREVIA

Здобутки клінічної і експериментальної медицини ◽

10.11603/1811-2471.2021.v.i3.12531 ◽

2021 ◽

pp. 162-165

Author(s):

D. M. Zhelezov

Keyword(s):

Blood Loss ◽

Postoperative Period ◽

Placenta Previa ◽

Statistical Processing ◽

Maternity Hospital ◽

Main Stage ◽

Satisfactory Condition ◽

Ultrasound Monitoring ◽

Group I ◽

Group Ii

The aim – to evaluate the effectiveness of preventive ligation of uterine vessels during caesarean section in women with placenta previa. Material and Methods. The study was conducted on the basis of the Regional Perinatal Center and Maternity Hospital № 5 (Odessa) for 2000–2020 and performing the main stage of cesarean section after reducing perfusion in the placenta. Uterine ligation was performed after fetal removal. The volume of blood loss, the condition of the mother and fetus were monitored, and perinatal results were analyzed. Statistical processing was performed by methods of variance and frequency analysis using Statistica 13.0 software (TIBCO, USA). Results. The mean age of pregnant women was 33.4±1.2 years. The clinic of placenta previa during pregnancy was extremely scanty. As a rule, the diagnosis was made during ultrasound monitoring. In 16 (17.7 %) there was repeated bleeding from the genital tract without pain and increased uterine tone, with the development of anemia of moderate severity. Single bleeding was observed in 53 (58.9 %) women. Blood loss was 1380±112 ml in group I, 466±34 ml in group II (p<0.05). The frequency of anemia in the postoperative period was 38.0 % and 17.5 %, respectively (p<0.05). All newborns were discharged on the 5-7th day of the postpartum period in satisfactory condition. There were no cases of distress syndrome. Conclusions: 1. The method of control of blood loss during placenta previa by ligation of the uterine arteries is effective – blood loss was in group I 1380±112 ml, in group II – 466±34 ml (p<0,05). 2. The frequency of anemia in the postoperative period was 38.0 in group I and 17.5 % in group II (p<0.05).

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Treatment Outcome of Adherent Placenta: An Experience at Tertiary Care Hospital

Annals of King Edward Medical University ◽

10.21649/akemu.v23i1.1494 ◽

2017 ◽

Vol 23 (1) ◽

Author(s):

Rabia Wajid ◽

Saira Bashir ◽

Asif Hanif

Keyword(s):

Treatment Outcome ◽

Blood Loss ◽

Gestational Age ◽

Uterine Artery ◽

Artery Ligation ◽

Morbidly Adherent Placenta ◽

Cesarean Hysterectomy ◽

Adherent Placenta ◽

Uterine Artery Ligation ◽

Internal Iliac

Objective: The objective of this study was to see treatment outcome of morbidly adherent Placenta.Methodology: This descriptive case series was carried out in Obstetrics and Gynae Unit-2 Lady Willingdon Hospital Lahore from January 2013 to December 2014. In this period 127 females between 20 to 45 years with any parity were enrolled in this study. All the patients were diagnosed for Placenta Accreta, Increta and Percreta by color flow Doppler. Operative delivery was carried out in all. Cesarean Hysterectomy with or without Placental separation, conservative measures (uterine artery ligation, tamponade and hemostatic sutures) and Internal iliac ligation were used. The outcome measures recorded were total blood loss, neonatal birth weight, mean gestational age at delivery, neonatal Apgar score, intra and postoperative complications and maternal mortality. Non-probability, sampling technique was used. The results were analyzed using SPSS version 20. Results: The mean age of subjects in this study was 26.77 ± 3.17 years. Gestational age at diagnosis and at surgery was 34.83 ± 1.94 weeks and 36.19 ± 1.557 weeks respectively. According to previous history of cesarean section, 60 (47.3%) had 1 previous C-section, 38 (29.9%) had 2 previous C-section and rest of 29 (22.9%) had ≥ 3 C-section. The diagnosis was made on Doppler Ultrasonography (USG) and the patients had surgery under emergency as well as elective conditions. We found that 96 (75.5%) females had Accreta, 27 (21.26%) had Increta and only 4 (3.15%) females had Percreta. Placental separation was done in 63 (49.6%) followed by Cesarean Hysterectomy were done in 36 (57%), and conservative measures like tamponade, haemostatic sutures in Placental bed and Uterine artery ligation in the rest i.e. 27 (43%). Non-separation of Placenta followed by direct Cesarean Hysterectomy was done in 64 (50.3%), and Internal iliac ligation was done in 30 (23%). During surgery the average blood loss was 2.97 ± 1.36 L. According to neonatal outcome Apgar score at 5 minutes was 5.69 ± 1.446 and weight of new baby was 2.85±0.30 kg. According to final outcome 83 (65.35%) females were successfully discharged, 29 (22.83%) had bladder rupture occurred in 29 (22.83%) while maternal mortality occurred in 15 (11.81%) only.Conclusion: An increasing number of patients with morbidly adherent Placenta is coming up along with the rising incidence of C-Section. The key to the management of this condition is prompt diagnosis and referral to well-equipped hospitals having multidisciplinary input. Conservative measures with uterine sparing are worth trying in selected cases.

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Anesthetic management in cesarean delivery of women with placenta previa: a retrospective cohort study

BMC Anesthesiology ◽

10.1186/s12871-021-01472-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dazhi Fan ◽

Jiaming Rao ◽

Dongxin Lin ◽

Huishan Zhang ◽

Zixing Zhou ◽

...

Keyword(s):

Cohort Study ◽

Blood Transfusion ◽

Blood Loss ◽

General Anesthesia ◽

Cesarean Delivery ◽

Retrospective Cohort ◽

Placenta Previa ◽

Neuraxial Anesthesia ◽

Estimated Blood Loss ◽

Maternal And Neonatal Outcomes

Abstract Background The incidence of placenta preiva is rising. Cesarean delivery is identified as the only safe and appropriate mode of delivery for pregnancies with placenta previa. Anesthesia is important during the cesarean delivery. The aim of this study is to assess maternal and neonatal outcomes of patients with placenta previa managed with neuraxial anesthesia as compared to those who underwent general anesthesia during cesarean delivery. Methods A retrospective cohort study was performed of all patients with placenta preiva at our large academic institution from January 1, 2014 to June 30, 2019. Patients were managed neuraxial anesthesia and general anesthesia during cesarean delivery. Results We identified 1234 patients with placenta previa who underwent cesarean delivery at our institution. Neuraxial anesthesia was performed in 737 (59.7%), and general anesthesia was completed in 497 (40.3%) patients. The mean estimated blood loss at neuraxial anesthesia of 558.96 ± 42.77 ml were significantly lower than the estimated blood loss at general anesthesia of 1952.51 ± 180 ml (p < 0.001). One hundred and forty-six of 737 (19.8%) patients required blood transfusion at neuraxial anesthesia, whereas 381 out of 497 (76.7%) patients required blood transfusion at general anesthesia. The rate neonatal asphyxia and admission to NICU at neuraxial anesthesia was significantly lower than general anesthesia (2.7% vs. 19.5 and 18.2% vs. 44.1%, respectively). After adjusting confounding factors, blood loss was less, Apgar score at 1- and 5-min were higher, and the rate of blood transfusion, neonatal asphyxia, and admission to NICU were lower in the neuraxial group. Conclusions Our data demonstrated that neuraxial anesthesia is associated with better maternal and neonatal outcomes during cesarean delivery in women with placenta previa.

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Surgical treatment of patients with sagittal imbalance of degenerative etiology: a comparison of two methods

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto202027316-26 ◽

2020 ◽

Vol 27 (3) ◽

pp. 16-26

Author(s):

Evgenii S. Baykov ◽

Alexey V. Peleganchuk ◽

Abdugafur J. Sanginov ◽

Olga N. Leonova ◽

Aleksandr V. Krutko

Keyword(s):

Surgical Treatment ◽

Blood Loss ◽

Perioperative Complications ◽

Sagittal Imbalance ◽

Radiological Parameters ◽

Results Of Treatment ◽

Group I ◽

Surgical Methods ◽

Group Ii ◽

Clinical And Radiological Results

Purpose. Compare the clinical and radiological results of treatment of patients with spinal deformities operated on using the PSO method and corrective fusion in the lumbar spine. Materials and methods. Retrospective monocenter cohort study. The data of 42 patients were analyzed. PSO (group I) was performed in 12 patients; 30 patients had a combination of surgical methods (group II) with mandatory ventral corrective spinal fusion at levels L4-L5, L5-S1. Clinical and radiological parameters were evaluated during hospitalization and at least 1 year later. Results. Postoperative hospitalization in group I 32.5 7.4 days, 27.1 7.4 in group II (p = 0.558758). The duration of the operation in group I was 402.5 55.6 minutes, in group II 526.0 116.2 minutes (p = 0.001124); blood loss 1862.5 454.3 ml versus 1096.0 543.3 ml (p = 0.000171). In both groups, significantly improved clinical and radiological parameters after surgery and after 1 year (p 0.05). In group II, as compared with group I after surgery and more than 1 year: lower back pain according to VAS (p = 0.015424 and p = 0.015424); below ODI after 1 year was (p = 0.000001). In group I, compared with group II after surgery and after 1 year, SVA is less (p = 0.029879 and p = 0.000014), lumbar lordosis is higher (p = 0.045002 and p = 0.024120), LDI is restored more optimally (p = 0.000001 and p = 0.000002), the GAP is lower (p = 0.005845 and p = 0.002639). The ideal Russoly type is restored more often in patients of group II (p = 0,00032). Complications in group I were noted in 12 (100%) patients, in group II in 13 (43.3%) patients (p = 0.001). Conclusions. In multistep surgical treatment compared with PSO, the anterior corrective interbody fusion L4-L5, L5-S1 reliably better and more harmoniously restores the sagittal balance parameters, has significantly lower volume of intraoperative blood loss, fewer perioperative complications and significantly improves the quality of life of patients.

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Minicraniotomy for Standard Temporal Lobectomy: A Minimally Invasive Surgical Approach

ISRN Neurology ◽

10.1155/2014/532523 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7

Author(s):

Faisal Al-Otaibi ◽

Monirah Albloushi ◽

Saleh Baeesa

Keyword(s):

Surgical Approach ◽

Skin Incision ◽

Cosmetic Outcome ◽

Adult Patients ◽

Temporal Lobectomy ◽

Question Mark ◽

Group I ◽

Estimated Blood Loss ◽

The Mean ◽

Group Ii

Introduction. The common surgical approach for standard temporal lobectomy is a question-mark skin incision and a frontotemporal craniotomy. Herein, we describe minicraniotomy approach through a linear skin incision for standard temporal lobectomy. Methods. A retrospective observational cohort study was conducted for a group of consecutive 21 adult patients (group I) who underwent minicraniotomy for standard temporal lobectomy utilizing a linear skin incision. This group was compared to a consecutive 17 adult patients (group II) who previously underwent a reverse question-mark skin incision and standard frontotemporal craniotomy. Results. The mean age was 29 and 23 for groups I and II, respectively. The mean estimated blood loss was 190 mL and 280 mL in groups I and II, respectively (P=0.019). Three patients in group II developed chronic postcraniotomy headache compared to none in group I. Cosmetic outcome was excellent in group I while 4 patients in group II developed disfiguring depression at lateral sphenoid wing and anterior temple. In group I 17 out of 21 became seizure-free at one-year followup. Conclusion. Minicraniotomy through a linear skin incision is a sufficient surgical approach for effective standard temporal lobectomy and it has an excellent cosmetic outcome.

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Fahmy's four quadrant sutures: a new technique for control of blood loss during cesarean delivery for placenta previa

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183291 ◽

2018 ◽

Vol 7 (8) ◽

pp. 3004

Author(s):

Mohamed S. Fahmy ◽

Laila Ezzat ◽

Maraey M. Khalil ◽

Ahmed H. Elsayed ◽

Sherif S. Fahmy ◽

...

Keyword(s):

Blood Loss ◽

Cesarean Delivery ◽

Simple Procedure ◽

Placenta Previa ◽

Suture Technique ◽

University Hospital ◽

New Technique ◽

Artery Ligation ◽

The Mean ◽

Four Quadrant

Background: The objective of this study is to assess the efficacy and safety of Fahmy's four quadrant suture technique (FFQS) in controlling blood loss during cesarean delivery for placenta previa (PP).Methods: The study was carried out in a tertiary University Hospital between January 2017 to December 2017 involved 12 women with heavy bleeding occurred after removal of the placenta from the lower section during cesarean delivery for PP. The FFQS technique consisted of two sutures to ligate the uterine branches on both sides and two sutures on the anterior and posterior wall of the lower uterine segment. Details regarding the management and maternal outcomes were recorded.Results: The mean age of the study participants was 29.58±5.29 years and the mean parity was 2.25±1.14. The mean gestational age at termination of pregnancy was 36.91±1.38 weeks. The mean duration of the whole surgery was 78.75±43.28 minutes, while the mean duration of FFQS technique was only 10±2.09 minutes. The technique was exclusively effective in 8 out of 12 cases (66.67%) while 2 cases needed bilateral internal iliac artery ligation and 2 cases needed hysterectomy. The mean amount of blood loss in all cases was 2433.33±833.76 ml. the mean amount of transfused packed RBCs was 3.92±1.68 units and fresh frozen plasma (FFP) was 3.42±1.44 units. All cases had uneventful postoperative course and no mortality cases in present series.Conclusions: The new technique; FFQS represents a rapid, effective, and inexpensive opportunity for women with bleeding from the lower segment of uterus due to PP. This simple procedure should be attempted before other complex measures to achieve good hemostasis.

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