scholarly journals Parallel loop binding compression suture, a modified procedure for pernicious placenta previa complicated with placenta increta: a retrospective study. (with video)

2021 ◽  
Author(s):  
Mengdi Fu ◽  
Hualei Bu ◽  
Yan Fang ◽  
Chunling Wang ◽  
Li Zhang ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Placenta Previa ◽  
Color Doppler ◽  
Operation Time ◽  
Placenta Increta ◽  
Parallel Loop ◽  
Qilu Hospital ◽  
Compression Suture ◽  
Magnetic Resonance Imaging Mri ◽  
Nicu Admission

Abstract Objective. To evaluate the efficacy and safety of parallel loop binding suture of the lower uterus during cesarean section in pernicious placenta previa complicated with placenta increta. Design. A retrospective study Setting. Qilu Hospital of Shandong University Population. Patients with pernicious placenta previa between November 2014 and December 2020 at the Qilu Hospital of Shandong University were eligible. Methods. The degree of placental invasion was evaluated using preoperative color Doppler ultrasonography and/or magnetic resonance imaging (MRI). Main outcome measures. Postpartum hemorrhage was evaluated as the primary outcome. Additionally, neonatal outcomes were evaluated. Results. Of the 38 patients, only 3 (7.89%) underwent hysterectomy due to massive blood loss. With parallel loop binding compression suture, the volume of blood lost ranged from 500 - 6000 (mean: 2152.63±1169.37) mL and the volume of blood transfused was between 400 - 3200 (1431.58±699.85) mL. The mean gestational age was 36 weeks and 2 days (range: 32+6 to39+6 weeks). The average operation time was 109.78 ± 33.49 min, and the average fetal childbirth time was 14.05±5.60 min. The rate of NICU admission was 36.84% (14/38). The postoperative menstrual cycle and menstrual flow both returned to normal levels. All infants at our hospital were safely discharged after treatment. Conclusion. Parallel loop binding compression suture is an effective, swift, practical, and safe method to reduce postpartum bleeding in women with pernicious placenta previa, complicated with placenta increta.

scholarly journals Parallel Loop Binding Compression Suture, a Modified Procedure for Pernicious Placenta Previa Complicated With Placenta Increta

2021 ◽  
Vol 8 ◽  
Author(s):  
Mengdi Fu ◽  
Hualei Bu ◽  
Yan Fang ◽  
Chunling Wang ◽  
Li Zhang ◽  
...  
Keyword(s):  
Placenta Previa ◽  
Operation Time ◽  
Control Group ◽  
Study Group ◽  
Placenta Increta ◽  
Parallel Loop ◽  
Admission Rates ◽  
Qilu Hospital ◽  
Compression Suture ◽  
Nicu Admission

Objective: To evaluate the efficacy and safety of parallel loop binding compression suture of the lower uterus during cesarean section in pernicious placenta previa complicated with placenta increta.Methods: This retrospective study was performed in patients with pernicious placenta previa complicated with placenta increta or percreta between November 2014 and December 2020 at the Qilu Hospital of Shandong University. Patients underwent parallel loop binding compression suture surgery were defined as study group, and patients underwent traditional surgery with figure-of-eight sutures as the main hemostatic method were defined as control group. Postpartum hemorrhage was evaluated as the primary outcome. The secondary outcomes included age, gestational weeks, operative time, fetal childbirth time, prevention of hysterectomy, blood transfusion, duration of postoperative catheterization, duration of antibiotic treatment, and postoperative hospitalization (days). Additionally, neonatal outcomes were evaluated.Results: A total of 124 patients were enrolled in the study, including 38 patients receiving parallel loop binding compression suture surgery in the study group, and 86 patients in the control group. With parallel loop binding compression suture, the average operation time was significantly reduced (109.0 ± 33.5 vs. 134.4 ± 54.2 min, p = 0.00), and the volume of blood lost were also decreased (2152.6 ± 1169.4 vs. 2960.5 ± 1963.6 ml, p = 0.02), which correspondingly reduced RBC transfusion (7.2 ± 3.5 vs. 10.3 ± 8.7 units, p = 0.03) and FFP transfusion (552.6 ± 350.3 vs. 968.0 ± 799.8 ml, p = 0.00). The fetal childbirth time was extended (14.1 ± 5.6 vs. 11.0 ± 8.0 min, p = 0.03), however, there was no increase in NICU admission rates (36.9 vs. 34.9%, p = 0.83). Except for one premature infant (32 weeks) death in the control group, all infants at our hospital were safely discharged after treatment.Conclusion: Parallel loop binding compression suture is an effective, swift, practical, and safe method to reduce postpartum bleeding in women with pernicious placenta previa, complicated with placenta increta. Besides, it has no adverse effects on newborns.

Association between Number of Prior Cesareans and Early Preterm Delivery in Women with Abnormal Placentation

2020 ◽  
Author(s):  
Ayamo Oben ◽  
Elizabeth B. Ausbeck ◽  
Melissa N. Gazi ◽  
Akila Subramaniam ◽  
Lorie M. Harper ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Preterm Labor ◽  
Placenta Previa ◽  
Secondary Analysis ◽  
Blood Products ◽  
Primary Analysis ◽  
Logistic Regression Models ◽  
Placenta Accreta Spectrum ◽  
Nicu Admission ◽  
Early Preterm Birth

Objective Delivery timing at 34 to 36 weeks is nationally recommended for pregnancies complicated by placenta accreta spectrum (PAS). However, it has recently been suggested that those with ≥2 prior cesarean deliveries (CD) and PAS should be delivered earlier than 34 weeks because of a higher risk of unscheduled delivery and complications. We sought to evaluate whether the number of prior CD in women with PAS is associated with early preterm delivery (PTD) (<34 weeks). We also evaluated the same relationship in women with placenta previa alone (without PAS). Study Design This is a secondary analysis of a multicenter and observational study that included women with prior CD (maternal–fetal medicine unit cesarean registry). Women with a diagnosis of PAS (regardless of placenta previa) were included for our primary analysis, and women with known placenta previa (without a component of PAS) were independently analyzed in a second analysis. Two groups of patients from the registry were studied: patients with PAS (regardless of placenta previa) and patients with placenta previa without PAS. The exposure of interest was the number of prior CD: ≥2 CD compared with <2 CD. The primary outcome was PTD <34 weeks. Secondary outcomes included preterm labor requiring hospitalization or tocolysis, transfusion of blood products, composites of maternal and neonatal morbidities, and NICU admission. Outcomes by prior CD number groups were compared in both cohorts. Backward selection was used to identify parsimonious logistic regression models. Results There were 194 women with PAS, 97 (50%) of whom had <2 prior CD and 97 (50%) of whom had ≥2 prior CD. The rate of PTD <34 weeks in women with ≥2 prior CD compared with <2 in the setting of PAS was 23.7 versus 29.9%, p = 0.27; preterm labor requiring hospitalization was 24.7 versus 13.5%; p = 0.05. The rates of plasma transfusion were increased with ≥2 prior CD (29.9 vs. 17.5%, p = 0.04), but there were no differences in transfusion of other products or in composite maternal or neonatal morbidities. After multivariable adjustments, having ≥2 CDs was not associated with PTD <34 weeks in women with PAS (adjusted odds ratio (aOR): 0.73, 95% confidence interval [CI]: 0.39–13.8) despite an association with preterm labor requiring hospitalization (aOR: 2.69; 95% CI: 1.15–6.32). In our second analysis, there were 687 women with placenta previa, 633 (92%) with <2 prior CD, and 54 (8%) with ≥2 prior CD. The rate of PTD <34 weeks with ≥2 CD in the setting of placenta previa was not significantly increased (27.8 vs. 22.1%, aOR: 1.49; 95% CI: 0.77–2.90, p = 0.08); the maternal composite outcome (aOR: 4.85; 95% CI: 2.43–9.67) and transfusion of blood products (aOR: 6.41; 95% CI: 2.30–17.82) were noted to be higher in the group with ≥2 prior CD. Conclusion Women with PAS who have had ≥2 prior CD as compared with women with <2 prior CD did not appear to have a higher risk of complications leading to delivery prior to 34 weeks. As such, considering the associated morbidity with early preterm birth, we would not recommend scheduled delivery prior to 34 weeks in this population. Key Points

scholarly journals Granulomatous orchitis: case report and review of the literature

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110037
Author(s):  
Liu Liang ◽  
Wang Jiajia ◽  
Li Shoubin ◽  
Qi Yufeng ◽  
Wang Gang ◽  
...  
Keyword(s):  
Color Doppler ◽  
Radical Resection ◽  
Blood Flow Imaging ◽  
Low Intensity ◽  
Disease Characteristics ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

We report the disease characteristics, diagnosis, and treatment of granulomatous orchitis. A 38-year-old man presented with a history of intermittent swelling, pain, and discomfort in the right testicle of 3 days’ duration. Unenhanced magnetic resonance imaging (MRI) of the testis and scrotum revealed an oval mass in the right testis measuring approximately 17 mm in diameter, with clear borders and a target ring-like appearance from periphery to center. T1-weighted imaging (T1WI) showed uniform low-intensity signals, and T2WI showed mixed high- and low-intensity signals. Diffusion-weighted imaging (DWI) signals were iso-intense, and the outer ring on enhanced scans showed progressive enhancement. We performed radical resection of the right testis under combined spinal–epidural anesthesia. The pathological diagnosis was granulomatous right orchitis. Two months postoperatively, ultrasonography showed no testis and epididymal echo signals in the right scrotum, and no obvious abnormalities; color Doppler blood flow imaging (CDFI) findings were normal. Granulomatous orchitis is rare in clinical practice, and the cause is unknown. The disease involves non-specific inflammation; however, it is currently believed that antibiotics and steroids are ineffective for conservative treatment, and orchiectomy should be actively performed.

Vasa previa: when antenatal diagnosis can change fetal prognosis

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Miriam Sutera ◽  
Anna Garofalo ◽  
Eleonora Pilloni ◽  
Silvia Parisi ◽  
Maria Grazia Alemanno ◽  
...  
Keyword(s):  
Risk Factor ◽  
Predictive Value ◽  
Placenta Previa ◽  
Color Doppler ◽  
Transvaginal Ultrasound ◽  
Spontaneous Resolution ◽  
Fetal Mortality ◽  
Second Trimester ◽  
Vasa Previa ◽  
Fetal Vessels

Abstract Objectives Evaluate ultrasound diagnostic accuracy, maternal−fetal characteristics and outcomes in case of vasa previa diagnosed antenatally, postnatally or with spontaneous resolution before delivery. Methods Monocentric retrospective study enrolling women with antenatal or postnatal diagnosis of vasa previa at Sant’Anna Hospital in Turin from 2007 to 2018. Vasa previa were defined as fetal vessels that lay 2 cm within the uterine internal os using 2D and Color Doppler transvaginal ultrasound. Diagnosis was confirmed at delivery and on histopathological exam. Vasa previa with spontaneous resolutions were defined as fetal vessels that migrate >2 cm from uterine internal os during scheduled ultrasound follow-ups in pregnancy. Results We enrolled 29 patients (incidence of 0.03%). Ultrasound antenatally diagnosed 25 vasa previa (five had a spontaneous resolution) while four were diagnosed postnatally, with an overall sensitivity of 96.2%, specificity of 100%, positive predictive value of 96.2%, and negative predictive value of 100%. Early gestational age at diagnosis is significally associate with spontaneously resolution (p 0.023; aOR 1.63; 95% IC 1.18–2.89). Nearly 93% of our patient had a risk factor for vasa previa: placenta previa at second trimester or low-lying placenta, bilobated placenta, succenturiate cotyledon, velametous cord insertion or assisted reproduction technologies. Conclusions Maternal and fetal outcomes in case of vasa previa antenatally diagnosed are significally improved. Our data support the evaluation of umbilical cord insertion during routine second trimester ultrasound and a targeted screening for vasa previa in women with risk factor: it allows identification of fetus at high risk, reducing fetal mortality in otherwise healthy newborns.

scholarly journals Antepartum hemorrhage and its fetomaternal outcome: a retrospective study

2020 ◽  
Vol 9 (11) ◽  
pp. 4562
Author(s):  
Saloni K. Gandhi ◽  
Ayushi P. Vamja ◽  
Kishor P. Chauhan
Keyword(s):  
Genital Tract ◽  
Neonatal Intensive Care ◽  
Distress Syndrome ◽  
Placenta Previa ◽  
Age Group ◽  
Cesarean Sections ◽  
Obstetrics And Gynaecology ◽  
Still Births ◽  
Abruptio Placenta ◽  
Nicu Admission

Background: Antepartum hemorrhage (APH) is defined as any bleeding from or into the genital tract after the period of viability and before the delivery of the baby. Aim of the research was to study the fetomaternal outcome in patients with APH.Methods: The present study was a retrospective observational study undertaken in Obstetrics and Gynaecology department of Dhiraj General Hospital, during a period of 1.5 years from November 2018 to May 2020 in 84 cases of antepartum hemorrhage. Only patients with APH >28 weeks gestational age and willing to participate in study were included. Open STAT statistical software has been used to analyse the data in this study.Results: The incidence of antepartum hemorrhage was 2.86%. Maximum patients of APH lie between the age group of 26-34 years. In abruptio placenta (AP) 65% and in placenta previa (PP) 77.2% of the patients were multiparous. APH presents mostly between 34-36 weeks. Around 90% patients of APH required blood transfusion. APH overall shows increased rate of cesarean sections upto 62%. Around 9.5% patients went into shock, 4.7% had disseminated intravascular coagulation (DIC), 3.5% postpartum hemorrhage (PPH) and 8.3% had wound gap and peurperial pyrexia. 23.8% babies had asphyxia of which 60% were contributed to PP and 40% were in AP group. Respiratory distress syndrome was in 7.1% babies of which both groups equally contributed. Septicemia was seen in 13% and jaundice in 29.8%.Conclusions: Higher rates of neonatal intensive care unit (NICU) admission and stay were seen with these complications. This study showed 20.2% perinatal deaths as outcome of APH and 14.2% still births. 

scholarly journals Role of emergency bilateral internal iliac ligation in postpartum hemorrhage

2021 ◽  
Vol 10 (8) ◽  
pp. 3086
Author(s):  
Sunder Pal Singh ◽  
Shipra Misra ◽  
Naresh Sharma
Keyword(s):  
Retrospective Study ◽  
Iliac Artery ◽  
Postpartum Hemorrhage ◽  
Internal Iliac Artery ◽  
Placenta Previa ◽  
Uterine Perforation ◽  
Life Saving ◽  
Internal Iliac ◽  
Early Decision

ABSTRACTBackground: The aim of the study was to determine the effectiveness of emergency bilateral internal iliac ligation in intractable postpartum hemorrhage.Methods: A retrospective study was done on 33 women who have undergone emergency bilateral internal iliac ligation in obstetrics haemorrhage.Results: In all of 33 women under this study bilateral internal iliac ligation was performed in emergency. (11) of the cases were of atonic PPH, placenta previa (8), uterine rapture (7), extension of C-section scar (3), vaginal and cervical laceration (3) and uterine perforation (1). hysterectomy was not performed in any of the cases. internal iliac artery was injured in one case during the procedure and was managed successfully but two patients died during and after the BIIL.Conclusions: BIIL is an effective, less time consuming and life-saving procedure in intractable obstetrics hemorrhage if early decision is taken and performed by practiced surgeons.

Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Cecilia Cavalli ◽  
Claudia Maggi ◽  
Sebastiana Gambarini ◽  
Anna Fichera ◽  
Amerigo Santoro ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Color Doppler ◽  
Histopathological Diagnosis ◽  
Resonance Imaging ◽  
Placenta Accreta Spectrum ◽  
Clinically Significant ◽  
Placental Lacunae

Abstract Objectives We aimed to assess the performance of ultrasound (US) and magnetic resonance imaging (MRI) signs for antenatal detection of placenta accreta spectrum (PAS) disorders in women with placenta previa (placental edge ≤2 cm from the internal uterine orifice, ≥260/7 weeks’ gestation) with and without a history of previous Caesarean section. Methods Single center prospective observational study. US suspicion of PAS was raised in the presence of obliteration of the hypoechoic space between uterus and placenta, interruption of the hyperechoic uterine-bladder interface and/or turbulent placental lacunae on color Doppler. All MRI studies were blindly evaluated by a single operator. PAS was defined as clinically significant when histopathological diagnosis was associated with at least one of: intrauterine balloon placement, compressive uterine sutures, peripartum hysterectomy, uterine or hypogastric artery ligature, uterine artery embolization. Results A total of 39 women were included: 7/39 had clinically significant PAS. There were 6/18 cases of PAS with anterior placenta: hypoechoic space interruption and placental lacunae were the most sensitive sonographic signs (83%), while abnormal hyperechoic interface was the most specific (83%). On MRI, focal myometrial interruption and T2 intraplacental dark bands showed the best sensitivity (83%), bladder tenting had the best specificity (100%). 1/21 women with posterior placenta had PAS. There was substantial agreement between US and MRI in patients with anterior placenta (κ=0.78). Conclusions US and MRI agreement in antenatal diagnosis of clinically significant PAS was maximal in high-risk women. Placental lacunae on ultrasound scan and T2 intraplacental hypointense bands on MRI should trigger the suspicion of PAS.

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