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

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.

scholarly journals Uterus-Preserving Treatment for Placenta Percreta by Reconstruction of the Lower Uterine Segment Using Wave Compression Suture: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Le Zhou ◽  
Chuntang Sun ◽  
Meng Chen ◽  
Guolin He ◽  
Xinghui Liu
Keyword(s):  
Placenta Previa ◽  
Suture Technique ◽  
Uterine Atony ◽  
Lower Uterine Segment ◽  
University Hospital ◽  
Artery Ligation ◽  
Hemostatic Effect ◽  
Hanging Maneuver ◽  
Wave Compression ◽  
Compression Suture

Abstract Purpose To observe the hemostatic efficacy of reconstructing the lower uterine segment by wave compression sutures (WCSs) in patients with placenta previa who underwent cesarean section (CS). Methods Retrospective analysis the medical records with placenta previa underwent WCS at the West China Second University Hospital of Sichuan University.One-hundred-and-twenty-three women who received WCSs as the first uterine suture technique from January 1, 2016, to December 31, 2020, were included in this study. The hemostatic effect of WCS was compared according to the type of placenta previa and the intraoperative situation. All patients were followed up after CS. Results The hemostatic effect during CS and postpartum hemorrhage were observed. Seventy-two (58.5%) patients successfully achieved hemostasis without further intervention. Fifty-one (41.5%) cases required additional uterine artery ligation (UAL), cervical hanging maneuver (CHM), and Bakri tamponade. Seventy-nine cases exhibited thin anterior walls and lower uterine atony after placental dissection; of these, 72 (91.1%) obtained hemostasis by WCS. No patient required repeat laparotomy or hysterectomy. There were no complications attributable to the WCS following surgery. Among the five patients who had a second pregnancy, no intrauterine adhesions or abnormal uterine morphologies were caused by WCS. No ectopic or incision pregnancies occurred. Conclusions Reconstruction of the lower uterine segment by WCS is a suitable technique for patients with thin anterior walls and uterine atony of the lower uterine segment along with placenta previa. WCS is easy to perform, effective, and safe.

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

BMC Surgery ◽  
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.

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

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.

scholarly journals Peripartum hysterectomy for cesarean section with morbidly adherent placenta: case series of 25 patients

2018 ◽  
Vol 7 (10) ◽  
pp. 3980
Author(s):  
Abdulrahman M. Rageh ◽  
Mohamed Khalaf ◽  
Ahmed M. Abbas ◽  
Hossam T. Salem
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Case Series ◽  
Bladder Injury ◽  
Operative Blood Loss ◽  
Ureteric Injury ◽  
Total Blood ◽  
Peripartum Hysterectomy ◽  
The Mean

Background: The current paper reports the outcome of case series of patients presented with placenta accreta confirmed histopathologicaly after management by peripartum hysterectomy.Methods: The study was set in Women’s Health Hospital, Assiut University, Egypt. This was a case series of 25 women presented with placenta accreta between May 2017 and April 2018. We included all pregnant women with placenta previa as diagnosed by ultrasound with suspicion of abnormal placentation by Doppler, confirmed intra-operatively undergoing either emergent or elective CS. All cases were performed by an expert team of obstetricians and anesthetists. Cesarean delivery was done under general anesthesia through pfannensteil incision. The primary outcome was the estimated intra-operative blood loss through assessment of amount of blood in the suction by ml, difference between the weight of surgical drapes and towels before and after operation.Results: Pre-operative Hb was 10.64±1.01 gm/dL and there was significant decline in the postoperative Hb reaching 8.36±1.21 gm/dL (p<0.001). The mean drop in Hb was 2.28±1.43gm/dL. Estimated intra-operative blood loss was 974.4±398.05 ml in the towels and 847.6±362.56 ml in the suction apparatus. The total blood loss was 1822±653.73 ml. The mean number of units of whole blood transfused was 2160.0±825.6 ml and fresh frozen plasma was 1010.0±349.7 ml. Regarding intra-operative complications, bladder injury was the most common one in 14 cases (56%), followed by ureteric injury in two cases (8%). Postoperative ICU admission was in 6 cases (24%) and the mean duration of hospital stay 12.44 ± 4.07 days. No cases of maternal mortality.Conclusions: In conclusion, peripartum hysterectomy is considered life-saving surgery in patients with placenta accreta.

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

2018 ◽  
Vol 7 (6) ◽  
pp. 2093
Author(s):  
Hany F. Sallam ◽  
Nahla W. Shady
Keyword(s):  
Blood Loss ◽  
Placenta Previa ◽  
Hypogastric Artery ◽  
Artery Ligation ◽  
Cesarean Hysterectomy ◽  
Adherent Placenta ◽  
Group I ◽  
Estimated Blood Loss ◽  
Group Ii ◽  
Foley’S Catheter

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.

scholarly journals Statistical Data About Risk Factors and Pregnancy Outcome of Placenta Previa

2018 ◽  
Vol 14 (15) ◽  
pp. 27
Author(s):  
Kashami Arian ◽  
Troshani Amela ◽  
Shabani Zamira
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Statistical Data ◽  
Placenta Previa ◽  
Economic Status ◽  
University Hospital ◽  
Uterine Surgery ◽  
Different Types ◽  
Maternal And Neonatal Outcomes ◽  
The Mean

Placenta previa is a placental location close to or over the internal cervical os. The aim of this study was to evaluate: risk factors, maternal and neonatal outcomes in patients with placenta previa. Material and methods: We conducted a retrospective cohort study of 38 women who have had a caesarean section for placenta previa at a tertiary referral University Hospital of Obstetrics and Gynecology “Koço Gliozheni” in Tirana, Albania. The period of this study was from January 2015 to March 2018. Maternal and neonatal data were obtained from medical records and the hospital database system. All cases of placenta previa were managed by medical team, obstetric consultants and all data were calculated with SPSS.20 program. Results: In total, 38 women with placenta previa were classified in three different types of placenta previa: Marginal placenta previa occurred in 16 women(42.1%), Complete placenta previa occurred in 19 women(50%) and with accreta placenta previa in 3 women(7.9%). The mean age of mothers was 30,61 years old, mode = 35, median = 30 and Std. deviation = 4.641 years. Conclusions: The prevalence rate of section caesarean and placenta previa is increased during the years. Several obstetrical factors have been found to be risk for placenta previa including: advancing maternal age, previous caesarean delivery, previous abortions, previous uterine surgery, multiparity, previous placenta previa, low socio-economic status, mother’s cigarette smoking /alcohol use. Placenta previa is associated with an increase in preterm birth and neonatal and maternal outcome. Other complications of pregnancy can be associated with placenta previa, but the majority of women deliver healthy babies.

scholarly journals Sutureless, bloodless, safe new circumcision technique

2017 ◽  
Vol 4 (8) ◽  
pp. 2530
Author(s):  
Wael Barakaat Ahmed Mohamed ◽  
Ahmed Eisa Ahmed
Keyword(s):  
Blood Loss ◽  
Prospective Observational Study ◽  
Harmonic Scalpel ◽  
Postoperative Bleeding ◽  
Suture Technique ◽  
University Hospital ◽  
Intraoperative Blood Loss ◽  
Minimal Complication ◽  
Male Patients ◽  
Surgery Department

Background: Several techniques of circumcision are available such as conventional surgical technique, the device (Gomco, Plastibell), mono and bipolar diathermy and sutureless methods such as fibrin glue. Our knowledge, the first report of using harmonic scalpel in circumcision was published by Peng et al, in the Asian journal of andrology but the study was done on dogs, this one of the little studies describe the use of the harmonic scalpel in male circumcision in humans. Aim was to describe the technique of the harmonic scalpel circumcision and report its outcomes in the term of safety and efficacy.Methods: This was a prospective observational study performed in the general surgery department at Sohag university hospital, Sohag, Egypt from 1st January 2015 to 31 December 2016.Results: 90 male patients were included in this study. Their age ranged between 3 and 18 years. The most common indication was religious circumcision 50%. No intraoperative blood loss or a postoperative bleeding. One case of wound infection and three cases of a postoperative edema respond to conservative treatment. No injury to the surrounding structure.Conclusions: The result of this study determines that the harmonic scalpel circumcision not associated with intraoperative blood loss or postoperative bleeding and a good postoperative cosmetic result, with a minimal complication. So, it is an appropriate alternative to the traditional scalp and suture technique.

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