A COMBINED ULTRASOUND AND CLINICAL SCORING MODEL FOR THE PREDICTION OF PERIPARTUM COMPLICATIONS IN PREGNANCIES COMPLICATED BY PLACENTA PREVIA

Introduction: Patients with placenta previa are at an increased risk of uncontrolled hemorrhage. Various clinical and ultrasound parameters can predict the risk of bleeding in these patients. Hence, the objective of our study is to develop a combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa. Methods: Fifty singleton pregnant women with placenta previa who underwent cesarean delivery in our hospital were included in the study. We collected clinical and ultrasound data prospectively, and the score was given to each parameter, and total score correlated with the occurrence of peripartum complications. Clinical parameters included age, parity, history of dilatation and evacuation, previous cesarean delivery, history of placenta previa, antepartum hemorrhage, and ultrasound parameters included type of previa, no. of lacunae in placenta, uteroplacental hypervascularity. The peripartum complications noted were the need for blood transfusion, uterine artery ligation, and cesarean hysterectomy. Results: According to the composite scoring done, uterine artery ligation was needed in more than 50% of patients at a score of 9–10. It increased to 100% as the score increased to ≥11. At a score of ≥12, hysterectomy was needed in around 75% of patients, and 100% of patients needed a blood transfusion. Univariate analysis using the Pearson Chi-square test was also done to know whether individual parameters and peripartum complications were significantly related that is p<0.05 with one another. Conclusion: The scoring system may serve to predict peripartum complications in pregnancies complicated by placenta previa.

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Bilateral uterine artery ligation plus intravenous tranexamic acid during cesarean delivery for placenta previa: a randomized double-blind controlled trial

Journal of Gynecology Obstetrics and Human Reproduction ◽

10.1016/j.jogoh.2018.10.023 ◽

2019 ◽

Vol 48 (2) ◽

pp. 115-119 ◽

Cited By ~ 5

Author(s):

Ahmed M. Abbas ◽

Nahla W. Shady ◽

Hany F. Sallam

Keyword(s):

Tranexamic Acid ◽

Cesarean Delivery ◽

Uterine Artery ◽

Placenta Previa ◽

Controlled Trial ◽

Artery Ligation ◽

Double Blind ◽

Uterine Artery Ligation

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The bleeding mother and her baby: a study to determine the fetomaternal outcome in cases of placenta previa

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203855 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3775

Author(s):

Preeti Frank Lewis ◽

Sana Tarannum Bijapur ◽

Deepika Gurnani

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Uterine Artery ◽

Placenta Previa ◽

Tertiary Care ◽

Previous History ◽

Fetal Outcome ◽

Care Hospital ◽

Artery Ligation ◽

Uterine Artery Ligation

Background: Placenta previa is one of the major causes for obstetric hemorrhagic morbidity and mortality with increasing incidence in recent times. This study aims at determining risk factors, maternal and fetal outcome associated with placenta previa.Methods: This was an observational, retrospective study conducted at a tertiary care hospital in Mumbai from May 2017 to March 2020. A total of 102 women with placenta previa during the study period were included, their case records critically analyzed to identify risk factors, maternal outcome in relation with blood transfusion required, ICU admission, obstetric hysterectomy and fetal outcome pertaining to prematurity, asphyxia and mortality.Results: A total of 102 patients were analyzed. Placenta previa was more common in >26 years of age, multipara (64.7%), with previous history of caesarean sections (21.5%) and previous curettage (11.7%), 44.2% babies born were preterm, 4.4% stillbirths and 8.5% neonatal deaths. Maternal complications like antepartum hemorrhage was seen in 58.8% patients and postpartum hemorrhage in 33.3%, blood transfusion was required in only 18 patients post operatively, bladder rent was seen in 3 patients and there was no maternal mortality. 44 patients required uterine artery ligation, Ashok Anand stitch was taken in 37 patients, uterus compression sutures in 10, obstetric hysterectomy in 7 patients and internal iliac artery ligation in 2 patients.Conclusions: Early identification of women at risk, obstetric preparedness and simple techniques like uterine artery ligation, Ashok Anand stitch and uterine compression sutures can help in effectively reducing need for multiple blood transfusions and morbidity.

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Uterine artery ligation before placental delivery during caesarean in patients with placenta previa accreta

Medicine ◽

10.1097/md.0000000000016780 ◽

2019 ◽

Vol 98 (36) ◽

pp. e16780 ◽

Cited By ~ 3

Author(s):

Jinxiao Lin ◽

Fengning Lin ◽

Yulong Zhang

Keyword(s):

Uterine Artery ◽

Placenta Previa ◽

Artery Ligation ◽

Uterine Artery Ligation

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The Bakri balloon implementation during cesarean section without switching to the lithotomy position

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2015-0078 ◽

2016 ◽

Vol 5 (2) ◽

pp. 81-84 ◽

Cited By ~ 1

Author(s):

Baris Kaya ◽

Abdullah Tuten ◽

Onur Guralp

Keyword(s):

Cesarean Section ◽

Uterine Artery ◽

Placenta Previa ◽

Daily Practice ◽

Lithotomy Position ◽

Artery Ligation ◽

Excessive Bleeding ◽

Uterine Artery Ligation ◽

First Time ◽

Bakri Balloon

Abstract Bakri balloon implementations for the conservative management of postpartum hemorrhage (PPH) have become more popular in the recent years. The procedure may be regarded as simple, however, it can become a challenging method considering an excessive bleeding patient where there is a race against time. In our daily practice we do not usually use the lithotomy position except for few conditions such as placenta previa, where the lithotomy position is necessary to apply a Bakri balloon during PPH during a cesarean section. Here we would like to present a woman with uterine atony and fundal placenta accreta bleeding, managed with the Bakri balloon without switching to the lithotomy position for the first time in the literature. The bleeding was evaluated successfully with this new method, however, a cesarean hysterectomy was necessary to achieve hemostasis despite the addition of a bilateral uterine artery ligation at the end. The decision to add a vessel ligation to the inflated Bakri balloon should be assessed carefully as uterine artery ligation may be time consuming due to effort of avoiding puncturing the balloon. On the other hand, internal illiac artery ligation may be more advantageous if the surgeon is experienced.

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