scholarly journals Cesaraean myomectomy: A lesson learnt

2021 ◽  
Vol 8 (3) ◽  
pp. 413-415
Author(s):  
Monika Anant
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Cesarean Section ◽  
Hemorrhagic Shock ◽  
Surgical Procedure ◽  
Case Reports ◽  
Case Selection ◽  
Life Threatening ◽  
Cesarean Myomectomy

Cesarean myomectomy (CM) has been a controversial surgical procedure. It is fraught with increased blood loss and its associated postoperative morbidities of anemia, blood transfusion and sepsis or even an unintended obstetric hysterectomy. This case reports a life-threatening hemorrhagic shock in a patient for whom 2 large myomas were extracted during cesarean section. Safety of CM depends on proper case selection with small sized, subserous, pedunculated fibroids and the speed and skill of surgeon.

scholarly journals Clinical spectrum and severity of hemolytic anemia in glucose 6-phosphate dehydrogenase–deficient children receiving dapsone

Blood ◽  
2012 ◽  
Vol 120 (20) ◽  
pp. 4123-4133 ◽  
Author(s):  
Allan Pamba ◽  
Naomi D. Richardson ◽  
Nick Carter ◽  
Stephan Duparc ◽  
Zul Premji ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Hemolytic Anemia ◽  
G6pd Deficiency ◽  
Case Reports ◽  
Drug Induced ◽  
Once Daily ◽  
Maximum Decrease ◽  
Life Threatening ◽  
The Mean ◽  
Glucose 6 Phosphate Dehydrogenase

AbstractDrug-induced acute hemolytic anemia led to the discovery of G6PD deficiency. However, most clinical data are from isolated case reports. In 2 clinical trials of antimalarial preparations containing dapsone (4,4′-diaminodiphenylsulfone; 2.5 mg/kg once daily for 3 days), 95 G6PD-deficient hemizygous boys, 24 G6PD-deficient homozygous girls, and 200 girls heterozygous for G6PD deficiency received this agent. In the first 2 groups, there was a maximum decrease in hemoglobin averaging −2.64 g/dL (range −6.70 to +0.30 g/dL), which was significantly greater than for the comparator group receiving artemether-lumefantrine (adjusted difference −1.46 g/dL; 95% confidence interval −1.76, −1.15). Hemoglobin concentrations were decreased by ≥ 40% versus pretreatment in 24/119 (20.2%) of the G6PD-deficient children; 13/119 (10.9%) required blood transfusion. In the heterozygous girls, the mean maximum decrease in hemoglobin was −1.83 g/dL (range +0.90 to −5.20 g/dL); 1 in 200 (0.5%) required blood transfusion. All children eventually recovered. All the G6PD-deficient children had the G6PD A− variant, ie, mutations V68M and N126D. Drug-induced acute hemolytic anemia in G6PD A− subjects can be life-threatening, depending on the nature and dosage of the drug trigger. Therefore, contrary to current perception, in clinical terms the A− type of G6PD deficiency cannot be regarded as mild. This study is registered at http://www.clinicaltrials.gov as NCT00344006 and NCT00371735.

scholarly journals Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252491
Author(s):  
Maria Regina Torloni ◽  
Monica Siaulys ◽  
Rachel Riera ◽  
Ana Luiza Cabrera Martimbianco ◽  
Rafael Leite Pacheco ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Cesarean Section ◽  
Post Partum ◽  
Average Risk ◽  
Limited Evidence ◽  
Post Partum Hemorrhage ◽  
Uterine Incision ◽  
Mean Differences ◽  
Calculated Average

Background There is no consensus on the best timing for prophylactic oxytocin administration during cesarean section (CS) to prevent post-partum hemorrhage (PPH). Objectives Assess the effects of administrating prophylactic oxytocin at different times during CS. Methods We searched nine databases to identify relevant randomized controlled trials (RCT). We pooled results and calculated average risk ratios (RR), mean differences (MD), and 95% confidence intervals (CI). We used GRADE to assess the overall evidence certainty. Results We screened 13,389 references and included four trials. We found no statistically significant differences between oxytocin given before versus after fetal delivery on PPH (RR 0.60, 95%CI 0.15–2.47; 1 RCT, N = 300) or nausea/vomiting (RR 1.21, 95%CI 0.69–2.13; 1 RCT, N = 300). There was a significant reduction in the need for additional uterotonics when oxytocin was given immediately before uterine incision versus after fetal delivery (RR 0.37, 95%CI 0.18–0.73; I2 = 0%; 2 RCTs; N = 301). Oxytocin given before fetal delivery significantly reduced intra-operative blood loss (MD -146.77mL, 95%CI -168.10 to -125.43; I2 = 0%; 3 RCTs, N = 601) but did not change the incidence of blood transfusion (RR 0.50, 95%CI 0.13–1.95; I2 = 0%; 2 RCTs, N = 301) or hysterectomy (RR 3.00; 95%CI 0.12–72.77; I2 = 0%; 2 RCTs, N = 301). One trial (N = 100) compared prophylactic oxytocin before versus after placental separation and found no significant differences on PPH, additional uterotonics, or nausea/vomiting. Conclusions In women having pre-labor CS, there is limited evidence indicating no significant differences between prophylactic oxytocin given before versus after fetal delivery on PPH, nausea/vomiting, blood transfusion, or hysterectomy. Earlier oxytocin administration may reduce the volume of blood loss and need for additional uterotonics. There is very limited evidence suggesting no significant differences between prophylactic oxytocin given before versus after placental separation on PPH, need for additional uterotonic, or nausea/vomiting. The overall certainty of the evidence was mostly low or very low due to imprecision. Protocol: CRD42020186797.

scholarly journals Complications of emergency obstetric hysterectomy in Gujarat, India

2017 ◽  
Vol 6 (11) ◽  
pp. 4950
Author(s):  
Bhoomika R. Chauhan ◽  
Aarti J. Patel
Keyword(s):  
Cesarean Section ◽  
Hemorrhagic Shock ◽  
Vaginal Delivery ◽  
Procedural Skill ◽  
Common Complication ◽  
Obstetric Hemorrhage ◽  
Operative Care ◽  
Life Threatening

Background: Emergency obstetric hysterectomy is defined as extirpation of uterus either at the time of cesarean section or following vaginal delivery, or within the puerperium to stop life threatening obstetric hemorrhage when all other measures fail. This study was conducted to study complications of emergency obstetric hysterectomy.Methods: Out of 28552 patients, 45 patients operated for Emergency obstetric hysterectomy in Vadilal Sarabhai Hospital of Ahmedabad, Gujarat; during May 2010 to October 2012 were included in the study. Complications of the procedures were identified and analyzed.Results: Hemorrhagic shock was the most common complication followed by fever. 15.55% (7 out 45) mothers were not saved even after the emergency obstetric hysterectomy.Conclusions: Improvising procedural skill and post-operative care can reduce the complications of emergency obstetric hysterectomy. 

scholarly journals Blood Transfusion in Obstetric Cases

2020 ◽  
pp. 197-200
Author(s):  
Ali Sungkar ◽  
Raymond Surya
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Massive Transfusion ◽  
Patient Blood Management ◽  
Blood Products ◽  
Blood Management ◽  
Transfusion Therapy ◽  
Massive Transfusion Protocol ◽  
Life Threatening ◽  
Transfusion Protocol

Objective: To discuss about blood loss in an obstetric setting, the role of blood transfusion, and patient blood management.Methods: Literature review.Results: Severe anaemia with hemoglobin level less than 7 g/dL or late gestation (more than 34 weeks) and/ or significant symptoms of anaemia, the recommendation is giving only single unit transfusion followed by clinical reassessment for further transfusion. In postpartum hemorrhage (PPH), massive transfusion protocols are commonly used description as large volume of blood products over a brief period to a patient with uncontrolled or severe hemorrhage, transfusion more than 10 RBC units within 24 hours, transfusion more than 4 RBC units in 1 hour with anticipation of continued need for blood, replacement of more than 50% of total blood volume by blood products within 3 hours. All obstetric units have a clear-cut massive transfusion protocol for the initial management of life-threatening PPH, considering early transfusion therapy with RBCs and FFP.Conclusion: Patient blood management aims to maintain hemoglobin concentration, optimize haemostasis, and minimize blood loss in effort to improve patient outcomes. Massive transfusion protocol in management of life-threatening should depend on each obstetric unit.Keywords: blood transfusion, obstetric cases, patient blood management.   Abstrak Tujuan: Untuk mendiskusikan tentang hilang darah dalam obstetric, peran transfusi darah, dan patient blood management.Metode: Kajian pustaka.Hasil: Anemia berat dengan nilai hemoglobin kurang dari 7 g/dL atau kehamilan lanjut (lebih dari 34 minggu) dan/ atau gejala nyata anemia, rekomendasi ialah memberikan satu unit transfusi diikuti dengan penilainan klinis untuk transfusi lebih lanjut. Pada perdarahan postpartum, protokol transfusi massif umum digambarkan sebagai volume darah yang dibutuhkan jumlah banyak dalam periode singkat, transfusi lebih dari 10 sel darah merah dalam 24 jam atau lebih dari 1 jam, penggantian lebih dari 50% total volume darah dalam 3 jam. Seluruh unit obstetric memiliki protokol transfusi massif yang jelas untuk taalaksana awal perdarahan postpartum dengan mempertimbangkan transfusi awal untuk komponen sel darah merah dan FFP.Kesimpulan: Patient blood management bertujuan untuk menjaga konsentrasi hemoglobin, optimalisasi hemostasis, dan minimalisasi hilang darah untuk meningkatkan luaran pasien. Protokol transfusi masfi dalam tatalaksana yang mengancam nyawa sangat bergantung pada setiap unit obstetrik.Kata kunci: kasus obstetri, patient blood management, transfusi darah  

scholarly journals Outcome of Cesarean Myomectomy: Is it a Safe Procedure?

2017 ◽  
Vol 77 (11) ◽  
pp. 1200-1206 ◽  
Author(s):  
Mehmet Senturk ◽  
Mesut Polat ◽  
Ozan Doğan ◽  
Çiğdem Pulatoğlu ◽  
Oğuz Yardımcı ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Blood Transfusion ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Maternal Age ◽  
Hemoglobin Level ◽  
Safe Procedure ◽  
The Mean ◽  
Cesarean Myomectomy ◽  
Duration Of Operation

Abstract Objective Myomectomy performed during cesarean section is still controversial because of the potential for associated complications, especially with large myomas. Many obstetricians avoid performing cesarean myomectomy procedures because of the risk of uncontrollable hemorrhage. However, the prevalence of pregnant women with myomas is increasing, leading to an increase in the likelihood that physicians will encounter this issue. The aim of this study was to compare outcomes and complications of patients who either had or did not have cesarean myomectomy. Method A total of 361 patients were evaluated in this retrospective study. Patients who had cesarean section with myomectomy and patients had cesarean section without myomectomy were compared with regard to demographics, drop in hemoglobin levels, complications, blood transfusion rates and duration of operation. These parameters were also compared when the diameter of the myoma was larger than 5 cm. Values of p < 0.01 and p < 0.05 were considered statistically significant. Results While maternal age and gravidity were similar in both groups (p > 0.05), the mean myoma diameter was smaller and the duration of operation was longer in the group who underwent cesarean myomectomy (p < 0.05). The reduction in hemoglobin level, rate of complications, and number of transfusions were similar in both groups (p > 0.05). Conclusion This study shows that myomectomy during cesarean section does not increase complications or transfusion rates and appears to be a safe procedure.

scholarly journals Our experience with intraoperative cell salvage during cesarean delivery in women with uterine myomas: Four case reports

2014 ◽  
Vol 67 (3-4) ◽  
pp. 111-117 ◽  
Author(s):  
Radmila Sparic ◽  
Biljana Lazovic ◽  
Nenad Sulovic ◽  
Snezana Buzadzic
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Case Reports ◽  
Mortality And Morbidity ◽  
Packed Red Blood Cells ◽  
Blood Salvage ◽  
Uterine Myomas ◽  
Cesarean Myomectomy ◽  
Risk Of Hemorrhage ◽  
Intraoperative Blood Salvage

Introduction. Cesarean section is more frequent in pregnant women with uterine myomas, and is usually complicated with perioperative hemorrhage. In some cases, cesarean myomectomy represents an inevitable surgery, adding risk of hemorrhage occurrence. Massive obstetric hemorrhage is the most common cause of maternal mortality and morbidity. The aim of this study was to show our experience and results of the implementation of intraoperative blood salvage during cesarean section in the patients with uterine myomas. Material and Methods. The study encompassed four patients with uterine myomas who had cesarean delivery at our Department in the period from 2010 to 2011. Results. Postoperative transfusion of packed red blood cells was given to one patient. No complications resulting form the intraoperative blood salvage were recorded in our research. Conclusion. Intraoperative blood salvage should be applied in patients with uterine myoma, and certainly in those who are planned for cesarean myomectomy and particularly in cases when massive intraoperative hemorrhage is expected.

scholarly journals Necrotizing Fasciitis and Toxic Shock Syndrome fromClostridium septicumfollowing a Term Cesarean Delivery

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
B. H. Rimawi ◽  
W. Graybill ◽  
J. Y. Pierce ◽  
M. Kohler ◽  
E. A. Eriksson ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Cesarean Delivery ◽  
Toxic Shock Syndrome ◽  
Surgical Procedure ◽  
Surgical Intervention ◽  
Case Reports ◽  
Obstetrics And Gynecology ◽  
Toxic Shock ◽  
Clostridium Septicum ◽  
Life Threatening

Necrotizing fasciitis and toxic shock syndrome are life-threatening conditions that can be seen after any surgical procedure. With only 4 previous published case reports in the obstetrics and gynecology literature of these two conditions occurring secondary toClostridium septicum, we describe a case of necrotizing fasciitis and toxic shock syndrome occurring after a term cesarean delivery caused by this microorganism, requiring aggressive medical and surgical intervention.

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 Evaluation of Safety in Cesarean Myomectomy

2016 ◽  
Vol 8 (2) ◽  
pp. 136-139
Author(s):  
Sabnam S Nambiar ◽  
S Ajith ◽  
Vidya Prabhu ◽  
Beena George
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Intraoperative Complications ◽  
Psychological Trauma ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Additional Surgery ◽  
Significant Difference ◽  
Cesarean Myomectomy

ABSTRACT Objectives Cesarean myomectomy (removal of fibroids during cesarean section) prevents an additional surgery, the cost, associated complications, and the physical and psychological trauma. However, there is risk of increased bleeding. Nevertheless, many centers practice it taking optimum precautions. The aim of our study was to compare cesarean myomectomy patients in those women who underwent cesarean section without fibroid removal for (a) blood loss, fall in hemoglobin, blood transfusion requirement; (b) intraoperative and postoperative complications; and (c) duration of hospitalization. Materials and methods We retrospectively studied medical records of cesarean sections done in our institution for women within the past 5 years. A total of 76 patients had documented fibroids, of whom 37 underwent concurrent myomectomy and 39 did not. Data were analyzed using Pearson's Chi-square test for categorical variables and student t test for continuous variables with threshold of significance p < 0.05. Results No significant difference was found in blood loss and intraoperative complications. A small increase was seen in febrile morbidity in myomectomy group, however, with no resultant increase in hospitalization. Conclusion Cesarean myomectomy does not cause increased morbidity. Moreover, it saves the mother an additional surgery of interval myomectomy provided proper selection of cases, adequate preoperative and intraoperative preparedness, and caution are taken into consideration. How to cite this article Nambiar SS, Ajith S, Prabhu V, George B. Evaluation of Safety in Cesarean Myomectomy. J South Asian Feder Obst Gynae 2016;8(2):136-139.

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