Effectiveness of ligation of uterine vessels prior to uterine incision for major placenta previa on reducing maternal morbidity without increasing neonatal morbidity

Background: Placenta previa causes massive obstetric haemorrhage and severe maternal morbidity. The objective is to analyse the effectiveness of uterine vessels (artery and vein) ligation before uterine incision in reducing blood loss and hysterectomy during caesarean section for major placenta previa without increasing morbidity in the newborn.Methods: A retrospective analysis of caesarean section for major placenta previa from 2002 to 2017 was done. Uterine vessels ligation before uterine incision was done in 52 patients. In 19 patients unilateral and in 33 patients bilateral uterine vessels ligation was done before uterine incision. In control group, 12 patients with major placenta previa uterine vessels were ligated after the removal of the placenta. The blood loss, blood transfusion, maternal morbidity and NICU admission of the newborns were compared.Results: The mean blood loss was 1002 ml in unilateral, 793 ml in bilateral uterine vessels ligation group, compared to 2191 ml in the control group. The mean blood transfusion volume 0.89 units in unilateral 0.60 units in bilateral ligation group while 2.33 units in the control group. The difference in blood loss and blood transfusion were statistically significant. Out of 52 babies, only 6 babies were admitted in NICU for mild depression with stay less than 3 days.Conclusions: Uterine vessels ligation before uterine incision reduces blood loss and hysterectomy during caesarean section for placenta previa without increasing the morbidity in the newborns.

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BLOOD LOSS DURING EMERGENCY CAESAREAN SECTION OF PLACENTA PREVIA IS MORE AS COMPARED TO ELECTIVE CAESAREAN SECTION

Pakistan Postgraduate Medical Journal ◽

10.51642/ppmj.v31i03.393 ◽

2021 ◽

Vol 31 (03) ◽

pp. 146-150

Author(s):

Sardar Muhammad Alfareed Zafar Zafar ◽

Mehvish Ilyas ◽

Saima Saeed Usmani ◽

Maryam Javaid ◽

Rizwana Tariq

Keyword(s):

Caesarean Section ◽

Blood Transfusion ◽

Blood Loss ◽

Cesarean Section ◽

Placenta Previa ◽

Emergency Caesarean Section ◽

Elective Cesarean Section ◽

Emergency Caesarean ◽

Elective Cesarean ◽

The Mean

Background: Placenta Previa is one of the major obstetric complication. It is a serious condition that may lead to severe morbidity and mortality. The risk of cesarean and blood loss, particularly, in emergency cesarean section. Objective: To compare the mean blood loss and need for blood or blood products with emergency versus elective cesarean section in females with placenta previa. Study design: Cohort study. Settings: Department of Obstetrics & Gynaecology. Duration: 3 months (April to June 2020). Method: Sample size of 70 patients were enrolled in the study through Non Probability, Consecutive Sampling. Patients of age 20-40 years, presented >24 weeks of pregnancy, with diagnosis of placenta previa were included. Then females were booked and were followed-up in OPD till delivery. Emergency cesarean section was done if active labor and bleeding started while elective cesarean was done on given date for delivery. Intraoperative blood loss and need for blood or blood components transfusion was noted. Data was recorded on proforma and analyzed by using SPSS version 22. Results: The mean age of females in emergency group was 30.80 ± 4.36 years and mean age of females in elective group was 31.06 ± 3.76 years. The mean gestational age of females at delivery in emergency group was 35.74 ± 2.89 weeks and in elective group was37.54 ± 0.70 weeks. The average blood loss during emergency caesarean section was 1471.43 ± 891.65 ml while during elective cesarean section, average blood loss was 1042.86 ± 402.41 ml (p<0.05). In emergency caesarean group, 7 (20%) did not require blood transfusion while 28 (80%) required blood transfusion. In elective caesarean group, 21 (60%) did not require blood transfusion while 14 (40%) required blood transfusion (p<0.05). Conclusion: Though this study, we found significantly higher blood loss and need for blood transfusion in emergency caesarean section as compared to elective caesarean sections for placenta previa.

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Caesarean myomectomy - a safe procedure: A retrospective case controlled study

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v2i2.1457 ◽

1970 ◽

Vol 2 (2) ◽

pp. 59-62 ◽

Cited By ~ 3

Author(s):

Alexander T Owolabi ◽

Oluwafemi Kuti ◽

Olabisi M Loto ◽

Oluwafemiwa N Makinde ◽

Adebanjo B Adeyemi

Keyword(s):

Caesarean Section ◽

Blood Loss ◽

Post Partum ◽

Uterine Fibroids ◽

Controlled Study ◽

Control Group ◽

High Dose ◽

Safe Procedure ◽

The Mean ◽

Duration Of Operation

Objective(s): The aim of the study is to determine whether myomectomy at the time of caesarean section leads to increase incidence of intrapartum and postpartum complications. Methods: Fourteen women, with uterine fibroids in pregnancy who were treated by caesarean myomectomy between January 2001 and June 2007, were compared retrospectively with fourteen women, without uterine fibroids who had routine caesarean section during the same period. Myomectomy for all types of myoma was performed at caesarean section after the delivery of the baby. Haemorrhage was controlled with the use of Foleys catheter tourniquet and high dose oxytocin infusion. The cases and control were analysed for age of the patient, parity, pre and post-operative haematocrit levels, duration of operation, blood loss, blood transfusions, and incidence of postpartum fever. Results: Caesarean myomectomy resulted in the mean blood loss of 589 ml (range 300-1300 ml) compared with 518 ml (range 350-850 ml) in the control group (p=0.376). The mean duration of operation was longer in the cases of caesarean myomectomy (66.8 mins) than those of the controls (56.4 mins). There were no significant differences between the two groups in the incidence of intraoperative haemorrhage, the need for blood transfusion, post partum fever, and length of hospital stay. Conclusions: This study shows that myomectomy during caesarean section is a safe procedure in experienced hands and is not as dangerous as generations of obstetricians have been trained to believe. Further research is necessary to establish the cost effectiveness of the procedure. Key words: myomectomy, cesarean section, hemorrhage doi:10.3126/njog.v2i2.1457 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 59 - 62

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MYOMECTOMY DONE DURING CAESAREAN SECTION

The Professional Medical Journal ◽

10.29309/tpmj/2006.13.02.5032 ◽

2006 ◽

Vol 13 (02) ◽

Author(s):

DR. MAHNAAZ ROOHI ◽

RAHILA FARHAT CH

Keyword(s):

Caesarean Section ◽

Blood Transfusion ◽

Blood Loss ◽

Hospital Stay ◽

Gestational Age ◽

Perinatal Outcome ◽

Maternal Morbidity ◽

Duration Of Hospital Stay ◽

Maternal Morbidity And Mortality ◽

Study Setting

Objective: To evaluate the outcome of myomectomy during caesarean section. Study Design: Aretrospective study. Setting: Gynae unit I, Allied Hospital Faisalabad . Period: From 2001 to 2002. Material andMethods: A total of 40 patients attending gynae unit I of Allied Hospital having pregnancy with fibroid were includedin the study. A special consent was taken from the patients for performing myomectomy. A performa was used to collectthe data regarding maternal morbidity and mortality and perinatal outcome, the results were then analyzed. Results:It was seen in this study that in 28 patients the duration of hospital stay was 7-10 days which is not more than the stayduring caesarean section. It was only in 02 patients the stay was more than 10 days. Regarding blood transfusion in90% of the cases required only two pint of blood during operation. Regarding blood loss in 20 patients it was only500ml. The loss was more than 1000 ml in only 04 cases. Perinatal outcome. The outcome was satisfactory and thebabies weight corresponded with the gestational age.

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Efficacy and safety of pre-operative single dose parenteral tranexamic acid in moderately anaemic parturients undergoing caesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173456 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3423

Author(s):

Robin Medhi ◽

Sonika Bawri ◽

Chaitra S.K. ◽

Mansur Ahmed ◽

Asmita Mishra

Keyword(s):

Caesarean Section ◽

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Postoperative Blood Loss ◽

Control Group ◽

P Value ◽

Study Group ◽

Total Blood ◽

Moderate Anaemia

Background: Preoperative administration of Tranexamic acid (TXA) has been found to be effective in reducing the amount of blood loss following Caesarean section in low risk women. However, studies in high risk women such as women with anaemia, where blood loss needs to be minimised are scarce.Methods: An experimental case control study was conducted with a total of 174 patients with moderate anaemia undergoing CS in a teaching hospital. Study group consisting of 87 patients received pre-operative TXA 1g intravenously. Intra operative and up to 6hours postpartum blood loss was calculated in both the groups. Requirement of blood transfusions were noted. Data analysed using Graphpad Instat® 3 statistical software.Results: Present study showed statistically significant reduction in intraoperative and postoperative blood loss among patients who received TXA compared to control group. The blood loss from placental delivery till completion of the procedure was significantly lowered (304.02ml vs 393.36ml; p value <0.0001). Postoperative blood loss (from end of the procedure up to 6hrs postpartum) was 62.57ml in comparison to 85.40ml in control group (p value <0.0001). The total blood loss from the placental delivery up to 6 hours postpartum was significantly reduced in study group (366.59ml vs 478.76ml; p value <0.0001). There was significant reduction of blood transfusion in study group (RR: 0.20, 95% CI, 0.045-0.887), without immediate adverse effect on mothers and new-borns.Conclusions: Administration of TXA preoperatively causes significant decrease in blood loss and the need for blood transfusion in patients with moderate anaemia undergoing CS.

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Effects of tranexamic acid in major orthopedic surgical procedures: a randomized comparative study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192561 ◽

2019 ◽

Vol 5 (4) ◽

pp. 551

Author(s):

Uganath Subash B. ◽

Sundaramoorthy M.

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Surgical Procedures ◽

Orthopedic Surgery ◽

Control Group ◽

Orthopedic Surgical Procedures ◽

The Mean ◽

The Difference ◽

And Control

Background: Despite modern healthcare system, major surgeries always cause economical constraints. Complications due to blood loss, long hospital stay are most common in major surgical procedures. Tranexamic acid (TXA), a synthetic derivative of lysine is used instead of blood transfusion to control bleeding peri and post operatively. Hence this study was planned to assess the effects of tranexamic acid on various orthopedic surgical procedures, in terms of blood loss, duration of surgical procedure and hospital stay.Methods: Prospective randomized comparative study, among patients undergoing elective and emergency orthopedic surgery. Patients with multiple fractures, organ injury and CKD were excluded from this study. Patients were randomized to tranexamic acid (TXA) group and colloids, blood transfusion group based on computer generated random numbers. Thirty two patients were randomized to tranexamic acid group and thirty two in control group. Statistical analysis was done using SPSS V 20.Results: The mean age group was 38.41±11.4 and 36.83±13.5 in TXA group and control group respectively. The mean SD for blood loss in TXA group was 321.5±124.7 and control group 482.7±189.6, the difference was found to be highly statistically significant with p=0.0002. Likewise the difference in postoperative Hb was found to be statistically significant with p<0.01. The p value for surgical site infection and hematoma was not statistically significant.Conclusions: TXA significantly reduces blood loss and blood transfusion requirements in patients undergoing orthopedic surgery.

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Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa: A retrospective cohort analysis

10.21203/rs.2.11801/v1 ◽

2019 ◽

Author(s):

Yushan Ma ◽

Xi Luo ◽

Xuemei Lin ◽

xiaoqin Jiang ◽

Hui Liu ◽

...

Keyword(s):

Blood Transfusion ◽

Cesarean Section ◽

Placenta Previa ◽

Group Versus ◽

Control Group ◽

Transfusion Rate ◽

Cell Salvage ◽

Blood Management ◽

Donor Blood ◽

Uterine Incision

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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Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽

10.1186/s12893-020-01027-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yoshikazu Nagase ◽

Shinya Matsuzaki ◽

Masayuki Endo ◽

Takeya Hara ◽

Aiko Okada ◽

...

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Cesarean Delivery ◽

Clinical Features ◽

Surgical Outcomes ◽

Multivariate Regression ◽

Placenta Previa ◽

Control Group ◽

Intraoperative Blood Loss ◽

Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

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Effect of Oral Erythropoietin in Prevention of Anemia of Prematurity

Bangladesh Journal of Child Health ◽

10.3329/bjch.v41i2.36106 ◽

2018 ◽

Vol 41 (2) ◽

pp. 101-109

Author(s):

Md Jamshed Alam ◽

Md Kamrul Ahsan Khan ◽

Nazmun Nahar ◽

Sanjoy Kumer Dey ◽

Md A Mannan ◽

...

Keyword(s):

Birth Weight ◽

Breast Milk ◽

Blood Transfusion ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Control Group ◽

Group Iii ◽

Anemia Of Prematurity ◽

The Mean ◽

Group Ii

Introduction: Anemia of prematurity (AOP) is a common problem of very low birth weight babies. Blood transfusion is a necessity when it occurs in moderate to severe form putting the child in to the risk of transfusion related complications. Erythropoietin, a potent stimulator of hemopoesis is available in breast milk in good amount and absorbed intact under physiologic condition. In this background oral recombinant human erythropoietin (rhEPO) can be a useful alternative to its subcutaneous administration in prevention of AOP.Objective: To evaluate the efficacy of oral rhEPO in the prevention of AOP in very low birth weight (VLBW) neonates.Methods: This randomized controlled study conducted in the NICU of BSMMU over one year. Total 60 preterm (<34 weeks)VLBW (<1500g) infants were enrolled and randomly divided into Control (group-I), Oral (group-II) and Subcutaneous (group III). Experimental groups (group-II & group-III) received rhEPO 400 IU/Kg, 3 times weekly in oral and subcutaneous (S/C) route respectively and continued for 2 weeks (Total 6 doses). Therapy was initiated 14 days after birth when the baby achieved oral feeding of at least 50 ml/kg/day of breast milk. All infants received oral iron and folic acid supplementation up to 12 weeks of postnatal age. Transfusion data were recorded. Anthropometric and hematological assessments were done at 2, 4, 6 and 12 weeks of age.Results: Baseline clinical characteristics and hematological values were almost similar in all groups. Mean hemoglobin were 11.34±0.68gm/dl, 11.88±0.54gm/dl& 12.12±1.32 gm/dl, the mean hematocrit were 34.11±2.03%, 35.66±1.65% & 36.38±3.97% and the mean reticulocyte were 7.56±2.48%, 9.85±1.50% & 9.22±3.11% in the control, oral and subcutaneous group respectively and the differences are statistically significant (p<0.05).Weight gain was higher in the intervention group at 6 and 12 weeks follow up than the control group(p<0.05).Only 2 (5.25%) infants, one in each of the intervention groups required blood transfusion, compared to 6 (31.5%) infants in control group (p<0.01).Conclusion: Oral EPO is as good as subcutaneous use of EPO in stimulating erythropoesis, maintaining HCT and Hb at high level and is safe in preterm baby.Bangladesh J Child Health 2017; VOL 41 (2) :101-109

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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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A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum haemorrhage in a tertiary care hospital in Bankura district of West Bengal, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201791 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1976

Author(s):

Rahul Kirtania ◽

Jayita Pal ◽

Sisir Biswas ◽

Aditi Aich

Keyword(s):

Randomized Controlled Trial ◽

Blood Loss ◽

Controlled Trial ◽

Active Management ◽

Control Group ◽

Care Hospital ◽

Normal Delivery ◽

Randomized Controlled ◽

Significant Difference ◽

The Mean

Background: PPH is the prime cause of maternal mortality worldwide. The incidence of PPH can be drastically combatted by application of uterotonic in active management of third stage labour. Timing of its administration is a matter of concern. This study aimed to assess whether timing of administration of oxytocin would have any impact on incidence or mean blood loss of PPH.Methods: It was a single blinded randomized controlled trial conducted in the department of Obstetrics and Gynecology, Bankura Sammilani Medical College for 6 months where 100 antenatal mothers admitted for normal delivery in labour room were allocated randomly in study and control group considering inclusion and exclusion criteria. Incidence of PPH and mean blood loss had been identified clinically by following them for 24 hours.Results: Only 9% of study population had experienced PPH. There was no statistically significant difference in incidence of PPH with difference in timing of administration of oxytocin (p >0.05). But there was statistically significant decrease in mean blood loss if oxytocin was administered before the placental delivery. The mean blood loss with oxytocin administered before placental delivery was 296.8 ml (102.45) and after placental delivery was 452.0 (128.87) ml respectively.Conclusions: Policy makers should keep in mind not only the incidence of PPH, but the mean blood loss amount too in a setting where anaemia in pregnancy is quite prevalent.

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