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

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

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

scholarly journals Vaginal ligation of descending branch of uterine artery in the management of massive secondary post-partum haemorrhage

2019 ◽  
Vol 8 (7) ◽  
pp. 2937
Author(s):  
Rudrika Chandra ◽  
Sanjay Singh
Keyword(s):  
Uterine Artery ◽  
Ultrasound Examination ◽  
Post Partum ◽  
Uterine Cavity ◽  
Placental Tissue ◽  
Haemorrhagic Shock ◽  
Sudden Onset ◽  
Bleeding Vessel ◽  
Vascular Ligation ◽  
Post Partum Haemorrhage

A 25 year old lady presented on day 22 of an uneventful caesarean delivery, in a state of class IV haemorrhagic shock, secondary to sudden onset of vaginal bleeding without any inciting cause. Immediate resuscitation was initiated and the cause for massive secondary post-partum haemorrhage (PPH) was identified as an actively bleeding vessel at 3 ‘O’ clock position on a visibly healthy cervix with a well contracted uterus. This was the descending branch of left uterine artery, which was ligated after pulling the cervix with a sponge holder towards the introitus and application of Vicryl No 1-0 suture. The bleeding decreased significantly post vascular ligation. Further exploration of vagina and cervix did not reveal any active bleeding or laceration and no retained placental tissue was found inside uterine cavity on ultrasound examination. This is a rare case of Massive Secondary PPH in a post-caesarean patient due to spontaneous giving way of descending branch of uterine artery.

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

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

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

scholarly journals Subinvolution of the placental site as the cause of hysterectomy in young woman

2021 ◽  
Vol 14 (2) ◽  
pp. e238945
Author(s):  
Olga Triantafyllidou ◽  
Stavroula Kastora ◽  
Irini Messini ◽  
Dimitrios Kalampokis
Keyword(s):  
Young Woman ◽  
Young Women ◽  
Postpartum Haemorrhage ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Fertility Sparing ◽  
Placental Site ◽  
Retained Products

Subinvolution of placental sites (SPSs) is a rare but severe cause of secondary postpartum haemorrhage (PPH). SPS is characterised by the abnormal persistence of large, dilated, superficially modified spiral arteries in the absence of retained products of conception. It is an important cause of morbidity and mortality of young women. In this study, we present a case of secondary PPH in a young woman after uncomplicated caesarean delivery who was deemed clinically unstable, and finally, underwent emergent total abdominal hysterectomy. We reviewed the literature with an emphasis on the pathophysiology of this situation. Treatment of patients with SPS includes conservative medical therapy, hysterectomy and fertility-sparing percutaneous embolotherapy.

Comparison of Efficacy of Refrigerated Oxytocin with Oxytocin Kept at Room Temperature for the Prevention of Post-Partum Haemorrhage in Vaginal Deliveries in a Tertiary Care Setting

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Pandey U
Keyword(s):  
Blood Loss ◽  
Low Income ◽  
Room Temperature ◽  
Postpartum Haemorrhage ◽  
Past History ◽  
Post Partum ◽  
Cold Chain ◽  
Vaginal Deliveries ◽  
History Of ◽  
The Mean

Introduction: Postpartum haemorrhage is one of the leading causes of maternal death worldwide and it accounts for nearly one-quarter of all maternal deaths and almost half of all postpartum deaths in low-income countries. Primary postpartum haemorrhage (PPH) is the most common form of major obstetric haemorrhage. Materials and Methods: The study protocol was comprised of Consent, Measurement of Pre-delivery Hemoglobin, Administration of the Intervention, Measurement of postpartum blood loss and Measurement of Post-delivery (24-48 hours) Hemoglobin. Blood loss was measured using a calibrated drape. The drape was placed beneath the parturient buttocks and secured around her abdomen with ties. Blood loss was monitored for a minimum of one hour and was continued in the second hour in case of persistent bleeding. The drape with the collected blood was weighed on a scale. The weight of the drape and the container in which it is placed was deducted from the total recorded weight in order to obtain the weight of the blood collected in the drape. Blood loss weight in grams was converted to milliliters by dividing the figure in grams by 1.06 (blood density in grams per milliliter). Results: The cross tabulations were used to study the demographic, obstetrical and medical factors in women with obstetrical haemorrhage. Table 1 shows the selected sociodemographic characteristics of the study population. The mean age of cases and controls are 26.333.559 and 26.853.873 respectively. On comparison, they are statistically insignificant. (p=0.324). The educational, occupational and socioeconomic status was comparable between cases and controls (p >0.05). Table 2 shows Antenatal, intra-partum and post-partum data in cases and controls. Discussion & Conclusion: It is a study done in North India comparing the Oxytocin kept at room temperature with failure of maintenance of cold chain during transport and storage and the refrigerated Oxytocin. It is the common understanding and general training that Oxytocin must be stored in the refrigerator, failing which its efficacy reduces i.e. it, will not be effective in controlling PPH. During the study we compared the mean blood loss and change in hemoglobin levels in cases and control and despite the fact that major risk factor for PPH for example past history of PPH, past history of D&C, prolonged third stage labour duration, manual removal of placenta were comparable in both cases and controls, still the mean blood loss and change in hemoglobin values was more in cases than controls. This could be attributed to usage of market oxytocin which had failed cold chain maintenance resulted in less effective oxytocin in prevention of PPH, Hence causing more blood loss and drop in hemoglobin values. This shows the need of room temperature stable uterotonic drug in LMIC’s like ours. Recently room temperature stable carbetocin shows the potential as an effective uterotonic drug for the prevention of PPH. However according to various studies carbetocin cannot be used for induction or augmentation of labour so it cannot replace oxytocin fully, rather it acts as a part of collective PPH reduction strategy.

Optimization of the treatment-diagnostic approach to manual vacuum-aspiration at post-partum pyo-inflammatory diseases

2018 ◽  
pp. 40-45
Author(s):  
O.V. Bulavenko ◽  
◽  
L.R. Ostapiuk ◽  
V.O. Rud ◽  
A.S. Voloshinovskii ◽  
...  
Keyword(s):  
Fluorescence Spectroscopy ◽  
Inflammatory Diseases ◽  
Post Partum ◽  
Uterine Cavity ◽  
Short Wave ◽  
Main Group ◽  
Optimal Time ◽  
Control Group ◽  
Vacuum Aspiration ◽  
Manual Vacuum Aspiration

The problem of postpartum pyo-inflammatory diseases requires the introduction of new approaches to its solution and optimization of diagnostic and therapeutic developments. The objective: was to determine the optimal time for manual vacuum aspiration of the uterus in postpartum endometritis, correction of therapeutic tactics and control of patients in the framework of the method of fluorescence spectroscopy. Materials and methods. The main group – 170 women with postpartum pyo-inflammatory diseases, control group – 40 women with uncomplicated course of the postpartum period. Their blood serum was examined using the method of fluorescence spectroscopy, in particular after manual vacuum aspiration of the uterus. Results. Fluorescence spectra were studied for 40 women of control group and 170 women of the main group, among them in 44 (25.8%) – in the dynamics during the treatment after manual vacuum aspiration of the uterine cavity. In 93.2% of the patients in the main group after it an increase in fluorescence intensity and max displacement in the short-wave region were recorded, which was a reliable sign of improving the condition of the patients. Conclusion. The use of the method of fluorescence spectroscopy in postpartum endometritis after manual vacuum aspiration of the uterus significantly helps to improve the monitoring of the process of treatment and, if necessary, to correct it in order to recover the patients in time. Key words: endometritis, manual vacuum aspiration of the uterus, the method of fluorescence spectroscopy.

scholarly journals Uterine leiomyoma: modern aspects of clinic, diagnosis and treatment

2021 ◽  
Vol 5 ◽  
pp. 7-18
Author(s):  
О.V. Golyanovskiy ◽  
O.Yu. Kachur ◽  
M.А. Budchenko ◽  
K.V. Supruniuk ◽  
S.V. Frolov
Keyword(s):  
Magnetic Resonance ◽  
Uterine Leiomyoma ◽  
Clinical Manifestations ◽  
Uterine Fibroids ◽  
Uterine Cavity ◽  
Diagnosis And Treatment ◽  
Scientific Publications ◽  
Genetic Components ◽  
Gynecology And Obstetrics ◽  
Gynecological Examination

According to the WHO, neoplastic processes of the uterus remain one of the important and relevant areas of modern gynecology. Uterine leiomyoma is one of the most common tumors of the female reproductive system. According to the latest data, every 4–5th woman in the world is diagnosed with leiomyoma, the incidence of which under the age of 35 reaches 50%, and according to autopsy data reaches 80%.The article provides a review of the scientific publications in recent years devoted to the study of the problem of uterine fibroids – relevance, causes and mechanisms of development, provides a classification, clinical manifestations, modern diagnostics and management tactics.The etiological factors of leiomyoma are numerous, there is no a single theory of the disease. Among the pathogenetic factors of leiomyoma are hormonal disorders, genetic components, infections, injuries. There are several classifications of leiomyoma, the most common classification was proposed by the International Federation of Gynecology and Obstetrics, which reflects the types of leiomatous nodes depending on their location and relationship to the uterine cavity and myometrium.Clinical manifestations of uterine fibroids range from asymptomatic to painful sighns and hemorrhagic syndromes, symptoms of compression of adjacent organs, the development of uterine bleeding, which lead to severe anemia. The nature of clinical features significantly depend on the localization of the leiomyoma nodes in the uterine body and their relationship to the uterine cavity (submucosal, intramural, subserous), as well as their number, size and blood supply.Modern diagnosis of leiomyoma is based on anamnesis, bimanual gynecological examination, ultrasound examination, and in some cases – magnetic resonance imaging and computed tomography examinations, hysteroscopy and laparoscopy. Today, the main methods of treatment of leiomyoma are conservative, surgical and radiological methods (uterine artery embolization, magnetic resonance-guided focused ultrasound).In addition to the listed modern aspects of the clinic, diagnosis and treatment of uterine leiomyoma, the article emphasizes the importance of preventive measures to reduce the incidence of this gynecological pathology.

scholarly journals The Hayman Technique: A Simple Method to Treat Postpartum Hemorrhage due to Placenta Praevia

2018 ◽  
Vol 30 (1) ◽  
pp. 66-69
Author(s):  
Shahela Jesmin ◽  
Nishat Anam Borna ◽  
Mosammat Nargis Shamima ◽  
Iftekhar Md Kudrate E Khuda ◽  
Shahin Mahmuda
Keyword(s):  
Postpartum Haemorrhage ◽  
Uterine Cavity ◽  
Placenta Praevia ◽  
Artery Ligation ◽  
College Hospital ◽  
Cross Sectional ◽  
Simple Method ◽  
Medical College ◽  
Compression Suture ◽  
Level Hospital

Aim: To assess effectiveness of Hayman suture to control postpartum haemorrhage due to placenta praevia during caesarean sectionMethods: It is a cross sectional observational study performed in Rajshahi Medical College Hospital, tertiary level hospital, from January 2016 to December 2016. It included 32 patients with PPH following placenta praevia during elective& emergency caesarean section (C/S). All 32 patients underwent horizontal compression suture (bilateral anteroposterior compression) of lower uterine segment. Vicryl 0 tapercut needle was used. All patients were followed postpartum for evaluation of uterine cavity and menstrual cycles.Results Hayman suture was applied in 32 cases. In 27 cases Hayman suture was the only intervention. Hayman with uterine artery ligation required in 2 cases. In 1 patient along with Hayman B-lynch compression suture was given and 2 patients required total hysterectomy.Conclusion: The quick and simple Hayman technique seems to be effective, safe, lifesaving method in stopping hemorrhage due to placenta praevia.TAJ 2017; 30(1): 66-69

Role of endogenous digitalis-like factors in the clinical manifestations of severe preeclampsia: a systematic review

2018 ◽  
Vol 132 (12) ◽  
pp. 1215-1242 ◽  
Author(s):  
Vardaman M. Buckalew
Keyword(s):  
Antihypertensive Drugs ◽  
Post Partum ◽  
Secondary Analysis ◽  
Clinical Manifestations ◽  
Antibody Fragment ◽  
Placental Tissue ◽  
Maternal Blood ◽  
Double Blind ◽  
Red Cell Membrane ◽  
Natriuretic Hormone

Endogenous digitalis-like factor(s), originally proposed as a vasoconstrictor natriuretic hormone, was discovered in fetal and neonatal blood accidentally because it cross-reacts with antidigoxin antibodies (ADAs). Early studies using immunoassays with ADA identified the digoxin-like immuno-reactive factor(s) (EDLF) in maternal blood as well, and suggested it originated in the feto–placental unit. Mammalian digoxin-like factors have recently been identified as at least two classes of steroid compounds, plant derived ouabain (O), and several toad derived bufodienolides, most prominent being marinobufagenin (MBG). A synthetic pathway for MBG has been identified in mammalian placental tissue. Elevated maternal and fetal EDLF, O and MBG have been demonstrated in preeclampsia (PE), and inhibition of red cell membrane sodium, potassium ATPase (Na, K ATPase (NKA)) by EDLF is reversed by ADA fragments (ADA-FAB). Accordingly, maternal administration of a commercial ADA-antibody fragment (FAB) was tested in several anecdotal cases of PE, and two, small randomized, prospective, double-blind clinical trials. In the first randomized trial, ADA-FAB was administered post-partum, in the second antepartum. In the post-partum trial, ADA-FAB reduced use of antihypertensive drugs. In the second trial, there was no effect of ADA-FAB on blood pressure, but the fall in maternal creatinine clearance (CrCl) was prevented. In a secondary analysis using the pre-treatment maternal level of circulating Na, K ATPase (NKA) inhibitory activity (NKAI), ADA-FAB reduced the incidence of pulmonary edema and, unexpectedly, that of severe neonatal intraventricular hemorrhage (IVH). The fall in CrCl in patients given placebo was proportional to the circulating level of NKAI. The implications of these findings on the pathophysiology of the clinical manifestations PE are discussed, and a new model of the respective roles of placenta derived anti-angiogenic (AAG) factors (AAGFs) and EDLF is proposed.

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

1970 ◽  
Vol 2 (2) ◽  
pp. 59-62 ◽  
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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