scholarly journals Diagnostic Limitation and Outcome of Definitive Surgical Approach in Placenta Accreta Spectrum Disorders - A Prospective Case Series Study

2021 ◽  
Vol 8 (07) ◽  
pp. 359-363
Author(s):  
Suman Poddar ◽  
Shilpi Sharma
Keyword(s):  
Surgical Approach ◽  
Internal Iliac Artery ◽  
Case Series ◽  
Bladder Injury ◽  
Artery Ligation ◽  
Total Hysterectomy ◽  
Obstetric Haemorrhage ◽  
Internal Iliac ◽  
Placenta Accreta Spectrum ◽  
Prospective Case Series

BACKGROUND Placenta accreta spectrum (PAS) disorders have become an emerging obstetric issue associated with risk of massive obstetric haemorrhage on placental separation following delivery. Antenatal diagnosis is of utmost importance but miserably limited due to lack of imaging expertise in this issue. We wanted to evaluate antenatal diagnosis of PAS disorders and analyse the outcome of definitive surgical approach. METHODS This is a prospective case series analysis done in the Department of Obstetrics and Gynaecology, RG Kar Medical College & Hospital, Kolkata. In a series, we have discussed 10 cases dealt well in our institution in the last one year (pre-Covid-era). Main outcome measures were operative blood loss, bladder injury, high dependency unit (HDU) admission, component transfusion, and neonatal morbidity. RESULTS Imaging expertise for prenatal diagnosis of PAS disorders was found miserably limited where 7 out of 10 cases were diagnosed intra-operatively. During Caesarean section (CS), longitudinal fundal incision was given to take out the baby with blood loss even less than usual CS. Bladder injury was diagnosed in one occasion intra-operatively. Peripartum total hysterectomy without touching placental bed was done in all cases, where uneventful bladder dissection and bilateral internal iliac artery ligation minimised component transfusion (8 out of 10) and HDU support (5 out of 10). Neonatal outcome was good in cases of planned CS at 36 weeks (6 out of 10). CONCLUSIONS Clinical suspicion plays an important role in our scenario due to lack of imaging experience & expertise to diagnose PAS disorders. Planned Caesarean delivery at late preterm period in equipped centre in expert hands improves outcome of such cases. Peripartum total hysterectomy without touching placental bed is the most definitive (surgical) approach with sound post-operative recovery. KEYWORDS Massive Obstetric Haemorrhage, Prenatal Diagnosis, Clinical Suspicion, Peripartum Total Hysterectomy, Internal Iliac Artery Ligation

scholarly journals Emergency bilateral internal iliac artery ligation in massive obstetric haemorrhage: 5 years experience At Tertiary Care Hospital.

2020 ◽  
Vol 27 (12) ◽  
pp. 2691-2695
Author(s):  
Saadia Saleem ◽  
Tasnim Tahira ◽  
Naureen Javed ◽  
Sumera Tahir
Keyword(s):  
Retrospective Study ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Tertiary Care ◽  
Care Hospital ◽  
Ureteric Injury ◽  
Artery Ligation ◽  
Internal Iliac Artery Ligation ◽  
Obstetric Haemorrhage ◽  
Internal Iliac

Objectives: To study the efficacy and safety of emergency bilateral internal iliac artery ligation (BIAL) in arresting massive obstetric haemorrahge. Study Design: Retrospective study. Setting: Department of Obstetrics and Gynaecology Unit-I, Allied Hospital, Faisalabad. Period: January 2014 to December 2018. Material & Methods: Fifty eight (58) patients with obstetric haemorrhage were included in this retrospective study. Bilateral internal iliac artery ligation was performed to control massive postpartum haemorrhage, post-operative internal haemorrhage. Results: The fifty eight (58) women underwent BIAl. Booked cases were onlhy (27%) and (73%) were unbooked. Out of 58 women 16(27%) women were with morbid adherent placenta, 14(24%) with uterine atony, 11(19%) uterine rupture, 9(17%) post-operative internal haemorrhage and 8(13%) coagulopathy were underwent BIAL. Out of 58 women 15(36%) ended in hysterectomy because of failure to control bleeding and uterus preserved in (64%). Overall efficacy in term of saving maternal life was 90%. One women had ureteric injury that was managed by Urologist. One another patient required re-laparotomy for persistant internal haemorrahge. Conclusion: Bilateral internal iliac artery ligation is safe and effective technique to control massive obstetric haemorrhage. Timely decision is also important to prevent hysterectomy. BIAL should include in algorithm to control intractable obstetric haemorrhage and consultant obstetricians and gynaecologist should learn that technique.

How B-Lynch suture and bilateral internal iliac artery ligation saved the uterus of a young patient with severe postpartum haemorrhage

2021 ◽  
Vol 14 (8) ◽  
pp. e244226
Author(s):  
San San Win ◽  
Helen Benedict Lasimbang ◽  
Sai Nay Lynn AUng ◽  
Tat Boon Yeap
Keyword(s):  
Young Patient ◽  
Iliac Artery ◽  
Postpartum Haemorrhage ◽  
Internal Iliac Artery ◽  
Artery Ligation ◽  
Internal Iliac Artery Ligation ◽  
Obstetric Haemorrhage ◽  
Future Fertility ◽  
Obstetric Emergencies ◽  
Internal Iliac

Obstetric haemorrhage is the leading cause of maternal death worldwide (27.1%) and more than 66% of its deaths were classified as postpartum haemorrhage (PPH). The most common cause of PPH is uterine atony. Obstetrician should be skillful in managing obstetric emergencies; especially pertaining to PPH. Application of the B-Lynch suture on an atonic uterus is one of the surgical options in PPH patients who wish to conserve the uterus and it has a very high success rate.We present a primigravida patient who developed massive primary PPH followed by disseminated intravascular coagulation, which was successfully managed with B-Lynch suture and bilateral internal iliac artery ligation. We described in detail regarding the management of massive PPH and application of these surgical procedures on the atonic uterus with an attempt to preserve the uterus and future fertility in this young patient.

scholarly journals Obstetric hysterectomy: a receding trend

2018 ◽  
Vol 8 (1) ◽  
pp. 353
Author(s):  
Fasiha Tasneem ◽  
Vijayalakshmi Shanbhag
Keyword(s):  
Internal Iliac Artery ◽  
Arterial Embolization ◽  
Artery Ligation ◽  
Pregnancy And Childbirth ◽  
Selective Arterial Embolization ◽  
Adherent Placenta ◽  
Obstetric Haemorrhage ◽  
Internal Iliac ◽  
Global Estimates ◽  
Made In

Over 500,000 women die each year due to complications of pregnancy and childbirth, a number that has remained relatively unchanged since 1990, when the first global estimates of the burden of maternal mortality were developed. Hemorrhage due to uterine atony, adherent placenta and PPH are still the causes of maternal death in developing countries. Although advances have been made in the development of conservative medical and surgical treatment of obstetric haemorrhage like brace sutures, internal iliac artery ligation, selective arterial embolization etc emergency obstetric hysterectomy remains a lifesaving procedure in the management of intractable haemorrhage unresponsive to conservative management.

Internal iliac artery ligation—a contemporary simplified approach

2021 ◽  
Author(s):  
Ari P. Sanders ◽  
Sebastian R. Hobson ◽  
Anna Kobylianskii ◽  
Jessica Papillon Smith ◽  
Lisa Allen ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Artery Ligation ◽  
Simplified Approach ◽  
Internal Iliac Artery Ligation ◽  
Internal Iliac

PROPHYLACTIC BILATERAL INTERNAL ILIAC ARTERY LIGATION, IN PREVENTION OF PPH, IN A CASE OF MULTIPLE LARGE INTRA MURAL FIBROIDS

2021 ◽  
pp. 83-84
Author(s):  
Aditi Gaiwal ◽  
Devdatta Dabholkar
Keyword(s):  
Blood Loss ◽  
Clinical Diagnosis ◽  
Iliac Artery ◽  
Postpartum Haemorrhage ◽  
Internal Iliac Artery ◽  
Artery Ligation ◽  
Internal Iliac Artery Ligation ◽  
Internal Iliac ◽  
Excessive Blood Loss

Postpartum haemorrhage is dened as a blood loss of more than 500ml after delivery of the placenta. It is a clinical diagnosis that encompasses excessive blood loss after delivery of the baby from a variety of sites: uterus, cervix, 1 vagina and perineum

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