scholarly journals Blood Saving Possibilities in Delivering Patients with Placenta Increta

2019 ◽  
Vol 14 (2) ◽  
pp. 67-75
Author(s):  
E. N. Plakhotina ◽  
T. N. Belousova ◽  
I. A. Kulikov ◽  
K. M. Pavlyutina ◽  
R. V. Latyshev
Keyword(s):  
Blood Loss ◽  
Massive Bleeding ◽  
Uterine Wall ◽  
Balloon Occlusion ◽  
Placenta Increta ◽  
Obstetric Hemorrhage ◽  
Massive Blood Loss ◽  
The Past ◽  
Temporary Balloon Occlusion ◽  
Large Vessels

According to the results of systematic reviews of WHO, maternal mortal-ity associated with massive bleeding almost reached 30% and has no tendency to decrease. Among the causes of massive obstetric hemorrhage, the most challenging ones are uterine hypotension and morbidity adherence placenta. Most severe complication for placentation is placenta increta in the uterine wall. Over the past 50 years, the number of cases with morbidity adherence placenta has in-creased tenfold. By all indications, this pathology has taken on the character of an epidemic and is one of the main causes for massive blood loss and blood transfusion, as well as peripartum hysterectomy. For surgical hemostasis in this pathology we apply X-ray vascular methods (temporary balloon occlusion of large vessels, vascular embolization), ligation of the iliac, uterine, ovarian arteries, various versions of distal hemostasis, including the use of uterine turnstiles, intrauterine and vaginal cylinders, compression sutures. However, data confirm-ing the advantage of any specified methods are not enough. The risk of massive bleeding is high while using any of these methods. The article analyzes the blood saving methods existing at the present stage and possibility of these methods usage in obstetrics. Besides, we describe efficacy and safety of their use in massive blood loss, including the surgical treatment of morbidity adherence placenta.

scholarly journals Peculiarities of cytolytic syndrome development with associated injury of the abdominal organs and massive blood loss in the experiment

2021 ◽  
Vol 11 (5) ◽  
pp. 229-236
Author(s):  
I. V. Kuzminskyi ◽  
V. K. Grodetskyi ◽  
H. Yu. Thymbalyuk
Keyword(s):  
Blood Loss ◽  
Research Group ◽  
Considerable Increase ◽  
Ischemia Reperfusion ◽  
Massive Bleeding ◽  
Abdominal Injury ◽  
Research Groups ◽  
Massive Blood Loss ◽  
Abdominal Organs ◽  
Thiopental Sodium

The function of the organs responsible for detoxification processes, in particular the liver, deserves a special role in the conditions of combined trauma. It is proved that ischemia-reperfusion of the limb caused by the imposition of a tourniquet, is the cause of significant toxemia. Under such conditions, it becomes clear that the detoxification function may be impaired, especially against the background of blunt combined trauma to the abdominal organs complicated by massive bleeding. Changes in the detoxification function of the liver are indicated by markers of the cytolytic syndrome. However, there is no clear understanding of how ischemia - limb reperfusion affects the development of cytolytic syndrome.Objective of research: to study the effect of massive blood loss associated with ischemia-reperfusion of the limb on the cytolytic syndrome indicators in case of injury of the abdominal organs.  Materials and methods. 100 mature albino male Wistar rats with the body weight of 190-220 grams kept on standard vivarium forage were used in the experiment. The animals were divided into the control and 3 research groups (containing 10 animals each). Arresting bleeding tourniquet was applied proximally on the lower limbs of rats from the first research group for 120 minutes under thiopental-sodium anesthesia (40 mg/kg-1), which caused development of ischemic-reperfusion.  Closed abdominal injury was simulated by means of delivering two dosed blows in the region of the abdominal cavity in the second research group; massive blood loss was simulated by means of cutting the femoral vessels and bloodletting from 25 to 30 % of the circulating blood volume in the group. Injuries from the first two groups were combined in the third group. The control group of animals received anesthesia without formation of any injuries. With the aim to determine alterations of cytolytic syndrome the activity of enzymes – markers of cytolytic syndrome ALT and AST were determined by means of a unified method.  The animals of the research groups were removed from the experiment under thiopental-sodium anesthesia by means of the total bloodletting from the heart.Results. Analysis of the results of the study found that cytolytic syndrome develops irrespective of the kind of injuries simulated. Thus, even during a day of post-traumatic period ALT and AST activity increases which is clearly registered in all the three research groups. Further destruction of cellular membranes increases till the 3rd day, which is manifested by a considerable increase of ALT and AST activity in the blood serum. This process continues till the 7th day. A tendency to ALT and AST decrease is observed only in the 1st group on the 7th day. Comparison of the 2nd and 3rd research groups within the time interval enables to understand that application of tourniquets on the limbs of animals with closed abdominal injury and massive bleeding deteriorates cytolytic processes.Conclusions: Simulated injuries in the research groups were associated with the occurrence of cytolytic processes possessing a tendency to develop in the period of early signs of traumatic disease.  Ischemic-reperfusion syndrome of the limbs accelerates considerably the development of systemic changes with abdominal injuries and hypovolemic shock, which was manifested by a considerable increase of ALT and AST parameters in the group with abdominal trauma and massive blood loss and becoming higher than that of the control in end of the experiment.

scholarly journals Abdominal Myomectomy for Huge Uterine Myomas with Intra-arterial Balloon Occlusion: Approach to Reduce Blood Loss

2019 ◽  
Vol 06 (S 01) ◽  
pp. S11-S21 ◽  
Author(s):  
Satoru Takeda ◽  
Tsuyoshi Ota ◽  
Hiroshi Kaneda ◽  
Yasuhisa Terao ◽  
Ryohei Kuwatsuru
Keyword(s):  
Blood Loss ◽  
Preoperative Assessment ◽  
Massive Bleeding ◽  
Subsequent Pregnancy ◽  
Balloon Occlusion ◽  
Iliac Arteries ◽  
Abdominal Myomectomy ◽  
Balloon Catheters ◽  
Internal Iliac ◽  
Internal Iliac Arteries

AbstractAbdominal myomectomy for a huge myomas, especially uterine cervical myoma, is difficult because of risks, such as intraoperative bleeding or injury to adjacent organs. Therefore, understanding of the positional relationships among a huge myoma, especially cervical or intraligamental myoma, and the vascular plexuses in the right and left cardinal ligaments is important for prevention of massive bleeding during myomectomy. While sufficiently performing preoperative assessment with pelvic examination, ultrasonography, magnetic resonance imaging (MRI), etc., surgeons should always keep in mind how they can reduce the blood loss volume, while safely and surely performing resections. For a cervical myoma of the uterus and giant uterine leiomyoma that leave no intrapelvic space and prevent palpation and identification of the uterine arteries and the internal iliac arteries, surgery can be performed safely by preoperatively placing balloon catheters in the internal iliac arteries. Hemostaic strategies for myomectomy and tips of subsequent pregnancy following myomectomy are also described.

scholarly journals Stopping life-threatening bleeding is one of the essential skills of simulation training in emergency medical care

2021 ◽  
Vol 1 (3) ◽  
pp. 119-120
Author(s):  
A. A. Chursin ◽  
A. S. Lytkina ◽  
A. V. Podoprigora ◽  
S. N. Boev
Keyword(s):  
Quality Of Care ◽  
Blood Loss ◽  
Simulation Training ◽  
Massive Bleeding ◽  
Emergency Medical Care ◽  
Severe Injuries ◽  
Massive Blood Loss ◽  
The World ◽  
Life Threatening

More than 5 million people around the world die every year from severe injuries and their complications, among which massive blood loss is in the first place. The introduction of practical exercises for training in stopping massive bleeding using simulators and modern means will not only improve the quality of care at the prehospital and early hospital stages, but also significantly improve the process of all simulation training.

scholarly journals Clinical evaluation of preoperative abdominal aortic balloon occlusion in patients with placenta increta or percreta

2019 ◽  
Author(s):  
Zhongmei Yang ◽  
Jie Mei ◽  
Yan Hou ◽  
Qinyin Deng ◽  
Mengwei Huang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cell Suspension ◽  
Interventional Therapy ◽  
Balloon Occlusion ◽  
Red Cell ◽  
Placenta Increta ◽  
Aortic Balloon Occlusion ◽  
Abdominal Aortic ◽  
Transfusion Volume ◽  
Blood Loss Volume

Abstract Background Placenta increta or percreta will result in severe postpartum hemorrhage and become a research hotspot in obstetrics. Preoperative abdominal aortic balloon occlusion (AABO), as a new intravascular interventional therapy, has taken more and more attention in obstetrics. Thus, the aim of this study is to evaluate the safety and efficacy of abdominal aortic balloon occlusion. Methods Retrospective analysis of pregnant women with placenta increta or percreta delivered between January 2013 and April 2019 in the Sichuan Provincial People’s Hospital. The experimental group (AABO group) included 168 patients who underwent abdominal aortic balloon occlusion before cesarean section. The control group (NO-AABO group) was composed of 106 patients who underwent surgery without any preoperative intravascular interventional therapy. The parameters containing estimated blood loss, red cell suspension (RCS) transfusion volume, hysterectomy, surgery time, postoperative hospital days, neonatal status and complications were compared between the two groups. Results The patients with preoperative abdominal aortic balloon occlusion had significant reduction in blood loss volume, red cell suspension transfusion volume and plasma transfusion volume compared to patients without balloon. Similarly, the surgery time and hysterectomy were obviously reduced in AABO group. However, there were no differences in the Apgar scores and neonatal complications between the two groups, indicating that the abdominal aortic balloon has little adverse effect on the newborns. Conclusion AABO is a safe and effective technology for pregnant women with placenta increta or percreta to reduce blood loss volume and blood transfusion volume.

scholarly journals Experience of performing organ-preserving surgeries in patients with true ingrowth of placenta in perinatal center of Samara Regional Clinical Hospital named after V.D. Seredavin

2020 ◽  
Vol 37 (3) ◽  
pp. 84-96
Author(s):  
O. B. Kalinkina ◽  
M. V. Nechaeva ◽  
Yu. V. Tezikov ◽  
I. S. Lipatov ◽  
O. R. Aravina ◽  
...  
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Perinatal Outcomes ◽  
Anterior Wall ◽  
Balloon Occlusion ◽  
Iliac Arteries ◽  
Clinical Hospital ◽  
Internal Iliac ◽  
Perinatal Center ◽  
Temporary Balloon Occlusion

In modern obstetrics, an abnormal placental invasion is a serious problem associated with the following high perinatal losses: massive obstetric bleeding that leads to the death of both the mother and the fetus. Objective. The purpose of the study was to analyze the methods of delivery in patients with placenta accreta. Materials and methods. The study group consisted of 31 patients aged 25 to 42 years with placenta ingrowth, who underwent metroplasty in the Perinatal Center of V. D. Seredavin Samara Regional Clinical Hospital in the period from May 2018 to December 2019. Most often, placental ingrowth was detected in the second trimester of pregnancy (41.94 %). In 5 cases, placental ingrowth was diagnosed in the operating room (16.3 %). On average, the time of detection of ingrowth is 24.96 weeks of gestation. Results. Out of 31 patients we observed, 27 underwent metroplasty using complex compression hemostasis, and 1 patient underwent temporary balloon occlusion of the internal iliac arteries. The total volume of blood loss was 1625 485 ml, and the median was 1455 ml. Only 5 (17.24 %) patients had a blood loss of more than 2000 ml, and there was no blood loss of more than 3000 ml. Conclusions. Introduction of organ-preserving operations allows maintaining a woman's reproductive health, avoiding massive blood loss, and improving perinatal outcomes. Patients with a scar on the uterus after cesarean section, with placentation on the anterior wall and in the area of the scar on the uterus should be immediately sent to the third level of rendering specialized medical care.

Evaluation of mid-term results of bipolar transurethral resection in the treatment of benign prostatic hyperplasia

2018 ◽  
pp. 1-9
Author(s):  
А.С. Векильян
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Blood Loss ◽  
Endoscopic Surgery ◽  
Transurethral Resection ◽  
Operating Time ◽  
Clinical Results ◽  
Massive Bleeding ◽  
Prostatic Hyperplasia ◽  
Surgical Methods

Представлены клинические результаты хирургического лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом до 100 см3 методом биполярной трансуретральной резекции простаты (БТУР -74 пациента) в сравнении с открытой чреспузырной простатэктомией (ОПЭ - 96 пациентов), ранее применявшейся для подобных клинических случаев в урологической клинике "Железнодорожной больницы" г. Волгоград. При статистически равном операционном времени обоих хирургических методов для БТУР отмечено существенное снижение интраоперационной кровопотери, сроков послеоперационной катетеризации и пребывания в стационаре, минимальная частота геморрагических и инфекционно-воспалительных осложнений. Наблюдение за урологическим статусом пациентов в течение первого послеоперационного года показало одинаковую клиническую эффективность сравниваемых хирургических методов. Значительное снижение объема кровопотери в ходе операции БТУР можно считать большим достижением, поскольку улучшение видимости в зоне хирургического вмешательства позволяет оптимизировать гемостаз, предотвратить массивные кровотечения как во время, так и после операции, сократить сроки послеоперационной катетеризации мочевого пузыря, что в свою очередь, снижает частоту развития инфекционно-воспалительных осложнений. Более быстрое восстановление пациентов после эндоскопических операций имеет медико-социальное и экономическое значение, поскольку минимальное количество послеоперационных осложнений и сокращение сроков госпитализации позволяет существенно снизить затраты на лечение и быстрее нормализовать качество жизни пациентов. Полученные результаты демонстрируют перспективность внедрения биполярных методов эндоскопических операций для лечения ДГПЖ в хирургическую практику урологических стационаров в целях повышения безопасности оперативного лечения и экономии затрат на госпитализацию. The clinical results of surgical treatment of benign prostatic hyperplasia (BPH) up to 100 cm3 by bipolar transurethral resection of the prostate (BTUR - 74 patients) in comparison with open transvesical prostatectomy (OPE - 96 patients), previously used for such clinical cases in the urological clinic "Railway hospital" in Volgograd are presented. With statistically equal operating time of both surgical methods, there was a significant decrease in intraoperative blood loss, the terms of postoperative catheterization and hospital stay, the minimum frequency of hemorrhagic and infectious-inflammatory complications. Observation of the urological status of patients during the first postoperative year showed the same clinical efficacy of the compared surgical methods. A significant reduction in the volume of blood loss during the operation, can be considered a great achievement, since the improvement of visibility in the area of surgical intervention allows to optimize the hemostasis, to prevent massive bleeding during and after surgery, to reduce the duration of postoperative bladder catheterization, which, in turn, reduces the incidence of infectious-inflammatory complications. Faster recovery of patients after endoscopic surgery of medical,social and economic importance, as the minimum number of postoperative complications and reduction of hospitalization can significantly reduce the cost of treatment and quickly normalize the quality of life of patients. The results demonstrate the prospects of the introduction of bipolar methods of endoscopic surgery for the treatment of BPH in the surgical practice of urological hospitals in order to improve the safety of surgical treatment and save costs for hospitalization.

Predictors of massive blood loss from placenta accreta: Wright et al

2011 ◽  
Vol 205 (1) ◽  
pp. 85-86
Author(s):  
Anthony Shanks ◽  
Jennifer McNamara ◽  
Meiling Hua ◽  
Jessica McPherson
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Massive Blood Loss
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