scholarly journals The Efficacy of Transarterial Embolization for Postpartum Hemorrhage Complicated with Disseminated Intravascular Coagulation: A Single-Center Experience

2021 ◽  
Vol 10 (18) ◽  
pp. 4082
Author(s):  
Daigo Ochiai ◽  
Seishi Nakatsuka ◽  
Yushi Abe ◽  
Satoru Ikenoue ◽  
Yoshifumi Kasuga ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Postpartum Hemorrhage ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Transarterial Embolization ◽  
Invasive Treatment ◽  
Intravascular Coagulation ◽  
Single Center Experience ◽  
Placenta Accreta Spectrum ◽  
The Mean

Indications for the use of transarterial embolization (TAE) for postpartum hemorrhage (PPH) have been established. However, the efficacy of TAE for PPH complicated by disseminated intravascular coagulation (DIC) remains controversial. In this study, we investigated the efficacy of TAE for PPH complicated by DIC. A database review was conducted to identify patients who were treated with TAE for PPH at our hospital. TAE was performed in 41 patients during the study period. Effective hemostasis was achieved in all cases, but additional procedures, such as re-embolization or hysterectomy, were required in five patients (12.2%). The typical causes of PPH included uterine atony (18 cases), placenta previa (15 cases), amniotic fluid embolism (DIC-type) (11 cases), and placenta accreta spectrum (10 cases). The mean blood loss was 3836 mL. The mean obstetrical DIC and the International Society on Thrombosis and Hemostasis DIC scores were 7.9 and 2.6, respectively. The efficacy of hemostasis was comparable between patients with and without DIC. However, the complete success rate of TAE was lower in patients with DIC as the condition worsened than that in non-DIC patients. Overall, TAE is effective as a minimally invasive treatment for PPH complicated by DIC.

scholarly journals Successful repeated uterine artery embolization in postpartum hemorrhage with disseminated intravascular coagulation: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shunya Sugai ◽  
Taro Nonaka ◽  
Kana Tamegai ◽  
Tatsuhiko Sato ◽  
Kazufumi Haino ◽  
...  
Keyword(s):  
Risk Factor ◽  
Disseminated Intravascular Coagulation ◽  
Postpartum Hemorrhage ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Placenta Previa ◽  
Blood Transfusions ◽  
Artery Embolization ◽  
Intravascular Coagulation ◽  
Uterine Arteries

Abstract Background Postpartum hemorrhage (PPH) is a potentially fatal condition requiring urgent and appropriate intervention. Uterine artery embolization (UAE) has a high hemostatic capacity for PPH, but it may fail. Disseminated intravascular coagulation (DIC) has been reported as a risk factor associated with the failure of UAE. Case presentation A 37-year-old primigravida with dichorionic diamniotic twins and placenta previa underwent cesarean section. The blood loss during surgery was 4950 mL. Hemostasis was achieved using an intrauterine balloon tamponade device. However, she lost a further 2400 mL of blood 5 h after surgery. We embolized both uterine arteries using gelatin sponges and confirmed hemostasis. She was suffering from DIC and received ample blood transfusions. However, a further 1300 mL of blood was lost 18 h after surgery and we performed repeated UAE, with complete recanalization of the uterine arteries on both sides and re-embolization with gelatin sponges. Her DIC was treated successfully by blood transfusions at this time, and she showed no further bleeding after the repeated UAE. Conclusions DIC is a risk factor for the failure of UAE. Repeated UAE may be effective after sufficient improvement of the hematological status in patients with PPH and DIC.

scholarly journals Maternal and fetal outcome in placenta accreta spectrum (PAS) associated with placenta previa: a retrospective analysis from a tertiary center

2021 ◽  
Vol 14 (3) ◽  
pp. 367-375
Author(s):  
◽  
◽  
◽  
Valentin Nicolae Varlas ◽  
Roxana Georgiana Bors ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cesarean Delivery ◽  
Conservative Management ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Maternal Blood ◽  
Uterine Preservation ◽  
Tertiary Center ◽  
Placenta Accreta Spectrum ◽  
The Mean

Accreta placenta spectrum is a complex obstetrical condition of abnormal placental invasion associated with severe maternal morbidity. This study aimed to analyze our therapeutic management and counseling of the cases with placenta accreta spectrum (PAS) associated with placenta previa. We performed a retrospective study of pregnant women with PAS associated with placenta previa at the Filantropia Clinical Hospital between January 2017–April 2021. In these cases, the earlier diagnosis was realized by an ultrasonographic scan and was confirmed by histopathological findings after the surgical treatment. The conservative management was obtained in one case at <37 weeks of gestation, and the maternal outcome was uterine preservation. Among the 12 patients, the mean age was 34±3.44 years. All women had risk factors for abnormally invasive placenta, such as placenta previa or previous cesarean delivery. Most women underwent planned cesarean delivery at the mean gestational age of 36.4±0.9 weeks. In our study, the uterus was preserved in only one case (8.33%), and hysterectomy with preservation of ovaries was performed in the rest of the cases. Mean maternal blood loss during surgery was 2175±1440 ml. Severe maternal outcomes were recorded only in one case (8.33%). We identified a low uterine preservation rate and a good perinatal outcome. Conservative management should be reserved for fertility desire and extensive disease due to surgical difficulty. Early identification of the risk factors and strategic management may improve maternal and fetal outcomes.

scholarly journals The value of the portable fibrinogen measuring device—a case report of severe postpartum hemorrhage with obstetric disseminated intravascular coagulation

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yoko Hikida ◽  
Hiroyuki Sumikura ◽  
Hisako Okada ◽  
Takashi Fujino ◽  
Mayumi Tanaka ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Postpartum Hemorrhage ◽  
Point Of Care ◽  
Fresh Frozen Plasma ◽  
Fibrinogen Concentration ◽  
Important Indicator ◽  
Measuring Device ◽  
Intravascular Coagulation ◽  
Estimated Blood Loss ◽  
Care Assessment

Abstract Background Fibrinogen concentration is an important indicator of the treatment for obstetric disseminated intravascular coagulation (DIC). We present how using the fibrinogen measuring device could solve problems in the treatment of postpartum hemorrhage with complicated DIC. Case presentation A 32-year-old woman with monochorionic diamniotic twins at 22 weeks of pregnancy was diagnosed with placental abruption and underwent emergent cesarean section. The estimated blood loss was 8375 g. She was transferred to our hospital for further treatment. Compressive uterine sutures and balloon tamponade were performed. We transfused fibrinogen and fresh frozen plasma actively during the operation to maintain plasma fibrinogen above 200 mg/dL by using a point-of-care fibrinogen measuring device. In spite of massive hemorrhage exceeding 10 L, she was extubated at the end of the operation and discharged on the 7th day after the operation. Conclusion The portable fibrinogen measuring device was useful for point-of-care assessment of obstetric DIC.

A Study of the Metabolism of Fibrinogen after Surgical Operations

1971 ◽  
Vol 41 (2) ◽  
pp. 141-152 ◽  
Author(s):  
J. A. Hickman
Keyword(s):  
Venous Thrombosis ◽  
Disseminated Intravascular Coagulation ◽  
Half Life ◽  
Plasma Fibrinogen ◽  
Intravascular Coagulation ◽  
Plasma Loss ◽  
The Mean ◽  
Chronic Disorders ◽  
Contrast Group ◽  
Surgical Operations

1. The turnover of fibrinogen was studied in twenty-eight patients after moderate and major surgical operations and in a contrast group of thirteen patients suffering from miscellaneous chronic disorders. 2. After operation the mean biological half-life of fibrinogen was 60.1 h (SD 16.4) and the mean plasma loss of fibrinogen was 40.1% (SD 12.6) of the intravascular fibrinogen pool each 24 h. In the contrast group, respective values of 96.2 h (SD 13.1) and 22.5% (SD 2.0) were obtained, which are in agreement with published values for the normal catabolism of fibrinogen. 3. When the post-operative increase in the plasma fibrinogen pool was taken into account, a massive increase in the absolute plasma loss of fibrinogen was observed with values approaching those reported for albumin turnover. 4. Possible sites of loss and the relevance of this investigation to the detection of disseminated intravascular coagulation and venous thrombosis are discussed.

scholarly journals Placenta Accreta Overlying a Caesarean Section Scar: A 10-Year Experience in a Tertiary-Care Centre in Portugal

2021 ◽  
Vol 34 (4) ◽  
pp. 266
Author(s):  
Margarida Cal ◽  
Carla Nunes ◽  
Nuno Clode ◽  
Diogo Ayres-de-Campos
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Team Approach ◽  
Tertiary Center ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Introduction: Placenta accreta spectrum disorders are among the leading causes of maternal morbidity and mortality and their prevalence is likely to increase in the future. The risk of placenta accreta spectrum disorders is highest in cases of placenta previa overlying a previous cesarean section scar. Few studies have evaluated placenta accreta spectrum disorders in Portugal. The aim of this study was to review the cases of placenta accreta spectrum overlying a cesarean section scar managed in a Portuguese tertiary center over the last decade.Material and Methods: Retrospective, cross-sectional study, with data collected from hospital databases. Only cases with histopathological confirmation of placenta accreta spectrum were included.Results: During the study period, 15 cases of placenta accreta spectrum overlying a cesarean section scar were diagnosed (prevalence 0.6/1000). All cases were diagnosed antenatally. A transverse cesarean section was present in all cases; 13 were managed by a scheduled multidisciplinary approach, while two required emergent management. Total or subtotal hysterectomy was performed in 12 cases. There were no cases of maternal or neonatal death. Histopathological evaluation confirmed nine cases of placenta accreta, three cases of placenta increta and three cases of placenta percreta.Discussion: Early antenatal diagnosis is important for a programmed multidisciplinary management of these cases, which may reduce potential morbidity and mortality and ensure better obstetric outcomes.Conclusion: This case series of placenta accreta spectrum overlying a cesarean section scar reports the reality of a tertiary-care perinatal center in Portugal, in which no maternal or neonatal mortality due to placenta accreta spectrum was registered over the last decade; this may be attributed to prenatal diagnosis and a coordinated multidisciplinary team approach.

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