Surgical Treatment of Early Postpartum Hemorrhage Caused by Lower Uterine Segment Atony

Abstract Purpose: Lower uterine segment atony is recently being recognized as one of the major reasons for early postpartum hemorrhage.Methods: We present our experience in surgical treatment of lower uterine segment atony patients that were delivered in our tertiary perinatal center during the 10 years period (2010-2019).Results: This particular study enrolled total number of 29 543 deliveries with 215 cases of early PPH (0,72%). LUSA was diagnosed in 44 cases or in 29,93% in all uterine atony cases. Exploration of the lower uterine segment accompanied by evacuation of the coagula was conducted in 5 cases (11,36%), haemostatic ligation procedures according to authors: Losickaja in 2 cases, Hebisch-Huch in 9 cases, Habek in 5 cases, Hebisch-Huch+Losickaja in 9 cases. Evacuation procedures were combined with ligation techniques in 7 cases, evacuation methods with ligation techniques and balloon tamponade in 2 cases, exploration combined with gauze tamponade in 1 case and ligation procedures with balloon tamponade in 3 cases. According to our results, haemostatic ligation procedures alone or combined with tamponade, have shown to be highly effective in 88,63%. Conclusion: Transvaginal approach for surgical treatment of lower uterine segment atony is accessible, feasible, successful and life saving. It can be easily performed in inpatient and outpatient care settings followed by administration of uterotonics, uterostiptics and tranexamic acid and fluid replacement. All of the above mentioned methods are of great importance in the prevention and treatment of obstetric hemorrhagic shock, development of coagulopathy, multiorgan failure, postpartum hysterectomy and finally vital for fertility preservation.

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Brief Report: A Case of Tramadol Overdose: Extracorporeal Life Support and Hemoperfusion as Life-Saving Treatment

Blood Purification ◽

10.1159/000505845 ◽

2020 ◽

Vol 49 (4) ◽

pp. 509-512 ◽

Cited By ~ 1

Author(s):

Fiorenza Ferrari ◽

Alessandro Carletti ◽

Nicola Peroni ◽

Silvia Mongodi ◽

Pasquale Esposito ◽

...

Keyword(s):

Medical Service ◽

Life Support ◽

Extracorporeal Life Support ◽

Multiorgan Failure ◽

Rebound Effect ◽

Metabolic Encephalopathy ◽

Life Saving ◽

Before And After ◽

Organ Failures ◽

Severe Shock

We describe the case of a 49-year-old woman with a Tramadol intoxication associated with multiorgan failure. Veno-arterial femoro-femoral extracorporeal life support (VA-ECLS) and hemoperfusion (HP) were used as rescue treatments. The emergency medical service found a woman at home unconscious. Once in the hospital, she was intubated and catecholamines support was immediately started for a severe shock. Brain CT was normal, whereas EEG revealed a metabolic encephalopathy pattern. Toxic levels of Tramadol and Quetiapine were detected. VA-ECLS was implanted due to persistent multiorgan failure, and HP with a charcoal cartridge was set to increase the Tramadol clearance. To quantify the charcoal cartridge’s removal efficiency of Tramadol, Tramadol concentration was measured before and after the cartridge and before and after the treatment in the patient’s blood. The charcoal cartridge showed good extraction ratio during the treatment and no significant rebound effect. VA-ECLS and HP allowed the patient to be weaned from vasoconstrictors and the resolution of the organ failures. These treatments might be lifesaving in the Tramadol intoxication.

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Autoinflammatory constrictive pericarditis and chronic myelomonocytic leukaemia: when one speciality is not enough

BMJ Case Reports ◽

10.1136/bcr-2018-228204 ◽

2019 ◽

Vol 12 (3) ◽

pp. e228204

Author(s):

Frances Varian ◽

Harpreet Kaur ◽

Stuart Carter ◽

Julian Gunn

Keyword(s):

Bone Marrow ◽

Surgical Treatment ◽

Cardiac Function ◽

Constrictive Pericarditis ◽

Inflammatory Markers ◽

Multiorgan Failure ◽

Intravenous Immunoglobulins ◽

Sustained Response ◽

High Dose ◽

Chronic Myelomonocytic Leukaemia

We present a case of constrictive pericarditis with concomitant blood and bone marrow appearances of chronic myelomonocytic leukaemia (CMML). Despite surgical treatment with pericardiectomy, the patient deteriorated into multiorgan failure. Pericardial histology disclosed a typical inflammatory picture with no evidence of monocytic or malignant infiltrate. Following intensive collaboration between cardiologists, haematologists and rheumatologists via daily email exchanges, a diagnosis was reached of autoinflammatory constrictive pericarditis with a non-infiltrative coexisting CMML. The key to achieving a rapid and sustained response was a trial of high-dose steroids followed by intravenous immunoglobulins. This achieved restoration of cardiac function, resolution of symptoms and near normalisation of inflammatory markers. A diagnosis of concurrent CMML was confirmed at 3 months. The patient remains well, taking colchicine and steroids.

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Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.6.3 ◽

2004 ◽

Vol 17 (6) ◽

pp. 1-7 ◽

Cited By ~ 58

Author(s):

Sascha Mann ◽

Michael Schütze ◽

Steffen Sola ◽

Jürgen Piek

Keyword(s):

Surgical Treatment ◽

Spinal Deformity ◽

Multiorgan Failure ◽

Vertebral Osteomyelitis ◽

Clinical Manifestations ◽

Neurological Deficits ◽

Causative Organism ◽

Delay In Diagnosis ◽

Pyogenic Spondylodiscitis ◽

Antibiotic Drugs

Object Pyogenic vertebral osteomyelitis is of special interest to neurosurgeons because it often results in acute neurological deterioration and requires a combination of adequate surgical and conservative treatment. The aim of the current study was to evaluate the strategy of a primary surgical approach to this disease. Methods A group of 24 patients with the clinical and radiological signs of acute pyogenic spondylodiscitis was prospectively followed from 1998 to 2004. Of these, 20 had underlying diseases such as diabetes mellitus, chronic alcoholism, and liver cirrhosis. The main causative organism was Staphylococcus aureus. Most infections were localized in the thoracic or lumbar spine (10 cases each); 15 infections were associated with epidural abscesses. Because of a delay in diagnosis, 13 patients presented with neurological deficits on admission. Patients with a complete or rapidly progressing neurological deficit underwent immediate surgery. In patients with minor or no deficits or in a stable neurological condition, surgery was delayed for 3 to 5 days. This group was treated with immobilization and intravenous antibiotic drugs before surgery. Surgical procedures included ventral, dorsal, and combined approaches in one- or two-stage operations. Antibiotic treatment included the use of broad-spectrum antibiotic drugs delivered intravenously for at least 10 days, followed by orally administered antibiotics for 3 months. Twenty patients were independent on follow-up review, 15 with no or minor handicaps. Severe septicemia and multiorgan failure developed in two patients, and these two died of their disease. Major complications were mainly due to long-term antibiotic therapy. Conclusions Surgical treatment is the modality of choice in patients with acute spinal osteomyelitis. It is especially indicated in patients with progressive or severe neurological deficits and spinal deformity. In experienced hands, surgery is safe and offers the advantages of spinal cord decompression, immediate mobilization, and correction of spinal deformity. The decision whether an anterior or posterior approach should be used must be made on an individual basis.

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THE PREVALENCE OF RETINOPATHY OF PREMATURITY UNDER THE CONDITIONS OF THE PERINATAL CENTER BASED AT THE CHILDREN’S MULTI-DISCIPLINARY HOSPITAL

Russian Pediatric Ophthalmology ◽

10.18821/1993-1859-2017-12-2-97-101 ◽

2017 ◽

Vol 12 (2) ◽

pp. 97-101

Author(s):

Nataliya Nikolaevna Sadovnikova ◽

N. V Prisich ◽

V. V Brzheskiy ◽

O. S Olina ◽

A. G Li ◽

...

Keyword(s):

Surgical Treatment ◽

Preterm Infants ◽

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Maternity Hospital ◽

Extremely Low Birth Weight ◽

Comprehensive Treatment ◽

Average Weight ◽

Number Of Children ◽

Perinatal Center

Introduction. Retinopathy of prematurity remains one of the most challenging problems in neonatal ophthalmology and the leading cause of blindness and disability in the young children. Purpose. The objective of the present study was to evaluate the prevalence of retinopathy of prematurity and the effectiveness of its treatment under the present conditions of nursing the preterm infants. Materials and methods. We carried out the ophthalmological observations and treatment of 393 premature children admitted to the Perinatal Centre of the Saint Petersburg State Pediatric Medical University during the period from 2014 to 2016 for the provision of the specialized care needed to manage various obstetric and perinatal pathological conditions. The patients included the children born with a body weight from 450 to 2500 g (average weight of 1056 ± 301,9 g) at the 23d to 33d weeks of gestation (mean age at birth 28,77 ± 2,37 weeks). Results. The frequency of retinopathy of prematurity and dynamics of its clinical course as well as the need for its laser and surgical treatment in such patients differed during these three years. The number of children with retinopathy of prematurity in the group with the extremely low birth weight increased from 75.0% in 2014 to 96.3% in 2016 largely due to the rise in the occurrence of the early stages of the disease among the preterm infants in combination with severe concomitant cardiosurgical and neurosurgical pathologies. 77.8% of the children in this group needed to be treated with the use of preventive retinal laser photocoagulation. However, only every third infant born at the 28-33d week of gestation actually received the required surgical treatment. The effectiveness of retinal laser photocoagulation increased from 85% in 2014 to 95% in 2016. Conclusion. The management of the preterm children presenting with retinopathy of prematurity based at the perinatal centre with the integrated maternity hospital and the multidisciplinary children’s hospital creates the optimal conditions for the comprehensive treatment of such patients

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Ruptured Cervicoisthmic Pregnancy with 20 Weeks Intrauterine Foetal Death Lying in Left Broad Ligament- A Case Report

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49375.15272 ◽

2021 ◽

Author(s):

Ruby Bhatia ◽

Khyati Sharma ◽

Trisha Arora ◽

Surbhi Gupta ◽

Disha Jindal

Keyword(s):

Transvaginal Ultrasound ◽

Broad Ligament ◽

Cervical Length ◽

Lower Uterine Segment ◽

Peripartum Hysterectomy ◽

Emergency Ultrasonography ◽

Life Saving ◽

Life Threatening ◽

Magnetic Resonance Imaging Mri ◽

Failed Induction

Abnormal Low Lying Implantation of Ectopic Pregnancy (LLIEP) may occur in cervix, cervico isthmic region or caesarean scar. Cervicoisthmic pregnancy remains the rarest form of LLIEP, a life threatening cause of maternal morbidity and mortality with an incidence of 1 in every 2400 to 4500 pregnancies. In isthmic implantation, the gestational sac is located more cranially and between the cervix distally and the decidualised functional endometrium cranially. Transvaginal Ultrasound (TVS), Colour Doppler and Magnetic Resonance Imaging (MRI) remain gold standard modalities for early diagnosis. Ultrasonography depicts bulging lower uterine segment with a normal cervical length and consistency. Here, the author reports a rare case of ruptured isthmic pregnancy with 20 weeks intrauterine foetus death lying in left broad ligament in a 33-year-old unbooked G3P2L2 with gestation of 31 weeks presenting in emergency. Ultrasonography depicted intrauterine foetus death with foetus lying in lower segment of uterus. Lower section caesarean section for failed induction confirmed hour glass uterus with empty upper uterine segment and bulging, distended, couvelaire lower uterine segment and left lateral rupture at cervicoisthmic junction. Dead 20 weeks foetus lying in leaves of left broad ligament. Peripartum hysterectomy was done as a life saving procedure. Cervicoisthmic pregnancy is rarest form of LLIEP and diagnosis may result in rupture with need of peripartum hysterectomy.

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Oesophageal Transection for Bleeding Varices: Case Report and Literature Review

Surgery Case Reports ◽

10.31487/j.jscr.2021.01.03 ◽

2021 ◽

pp. 1-2

Author(s):

Zandri Pienaar ◽

Sharon R Cacala ◽

George V Oosthuizen

Keyword(s):

Case Report ◽

Literature Review ◽

Variceal Bleeding ◽

General Surgeon ◽

Oesophageal Varices ◽

Balloon Tamponade ◽

Satisfactory Outcome ◽

Life Saving ◽

General Surgeons

Surgical oesophageal transection for uncontrolled variceal bleeding is a last resort measure that is rarely needed due to modern endoscopic advancements. Since it is infrequently required, most of the younger General Surgeons have not been exposed to this procedure. However, it remains a valuable consideration when endoscopic measures and balloon tamponade fail to control bleeding oesophageal varices and should remain in the armamentarium of the General Surgeon. Here we present a case of such a patient who underwent oesophageal transection as a life-saving procedure with satisfactory outcome, together with a brief literature review on this topic.

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Difficulties in breastfeeding: ways to solve the problem

Medical Council ◽

10.21518/2079-701x-2021-11-7-13 ◽

2021 ◽

pp. 7-13

Author(s):

E. Z. Polyanina

Keyword(s):

Medical Personnel ◽

First Year ◽

Mixed Feeding ◽

Herbal Tea ◽

Lactation Disorders ◽

Early Postpartum ◽

Nursing Mothers ◽

Long Time ◽

Perinatal Center ◽

Group 2

Introduction. Practical assistance of medical personnel to nursing women with difficulties in breastfeeding, joint search for solutions to the problem of hypogalactia contributes to the preservation of breastfeeding throughout the first year of a baby’s life.Purpose of the study. The frequency and nature of lactation disorders in women in the first weeks and months of breastfeeding were studied.Materials and methods. The attitude of women to various, including non-drug, methods of maintaining lactation was analyzed. The study was conducted following a survey of 58 women – patients of the perinatal center in the early postpartum period, 28 women whose children received breastfeeding/mixed feeding in the 1st year of life and 16 female employees of neonatological departments, whose children were also breastfed/mixed feeding in the 1st year of life. With women in groups 1 and 2 in the obstetric facility, there were talks about the benefits of breastfeeding and instructions on how to properly latch on the newborn to the breast. The respondents participated in the study only voluntarily.Results and discussion. Revealed approximately the same nature of lactation disorders in all groups. The predominance of women with hypogalactia after preterm birth was noted; breastfeeding up to one and a half to two years was observed in 4% of young women without chronic somatic pathology after the first spontaneous birth. Respondents of groups 1 and 3 showed high awareness and greater adherence to non-drug correction of hypogalactia in the form of the use of herbal tea. At the same time, some of the respondents in group 2 showed low motivation to maintain breastfeeding and were skeptical about any way to maintain lactation. Among the surveyed respondents, 47% (48 women out of 102) used herbal tea for a long time (3–6 weeks or more). All of them characterized as an effective lactogonic agent, and also noted a calmer behavior of the child, a decrease in intestinal colic and an improvement in the quality of night sleep.Conclusions. A data analysis of the survey of nursing mothers and women who had a breastfeeding experience showed that there is approximately the same pattern of lactation disorders regardless of the woman’s age, high or low awareness of breastfeeding issues.

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IMMEDIATE RESULTS OF TREATMENT FOR PYOGENIC NONSPECIFIC SPINE DESEASE

Hirurgiâ pozvonočnika ◽

10.14531/ss2005.2.70-72 ◽

2005 ◽

pp. 070-072

Author(s):

Mikhail Yuryevich Goncharov ◽

Vladimir Petrovich Sacovich ◽

Evgeny Petrovich Danilov ◽

A. V. Cherepanov ◽

I. V. Volkov ◽

...

Keyword(s):

Surgical Treatment ◽

Conservative Treatment ◽

Neurological Deficit ◽

Multiorgan Failure ◽

Intravenous Antibiotic ◽

Results Of Treatment ◽

Antibiotic Drugs ◽

Time To Diagnosis ◽

Spine Diseases ◽

Spine Disease

Pyogenic nonspecific spine disease is of special interest to neurosurgeons because it often results in acute neurological deteriorations and requires a combination of adequate surgical and conservative treatment. A group of 81 patients with the clinical and radiological sings of pyogenic nonspecific spine infections was prospectively followed from 1999 to 2004. Time to diagnosis was less than 2 months in 62,96 % of patients. Patients without neurological deficit (n = 8; 9.88 %) were conservatively treated with immobilization and intravenous antibiotic drugs. Patients with complete or rapidly progressing neurological deficit, septicemia (n = 73; 90.12 %) underwent surgery. Good results were achieved in 42 (57,55 %) patients, satisfactory – in 16 (21,91 %) with minor neurologic deficit, unsatisfactory – in 14 (19,17 %) with severe neurological deficit. Severe septicemia and multiorgan failure developed in one patient who died of this disease. Conclusions: еarly diagnosis and surgical treatment is a technique of choice for treatment of patients with pyogenic nonspecific spine diseases.

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