Giant placenta chorioangioma with postpartum bleeding and uterine atony

Chorioangioma is the most commonly occurring vascular, non-malignant placental tumor in pregnancy, with a reported incidence of 1% in all examined placentas. Nonetheless, real tumor incidence remains unknown because of small specimen sizes, which contributes to a lack of detection throughout the entire gestational period. Prenatal detection and diagnosis may be possible with ultrasound screening; however, most placental chorioangioma diagnoses are postnatal, based upon histopathological studies. This article report the case of postnatal diagnosis and associated complications in a 35-year-old patient with a 6 cm × 4 cm × 4 cm placental chorioangioma.

Comparison of efficacy of intramyometrial versus intramuscular prostaglandin F2α (PGF2α) in the management of primary postpartum hemorrhage due to uterine atony.

Objective: To determine the better route of prostaglandin F2α either intramyometrial or intramuscular for the management of uterine atony and to prevent surgical intervention. Study Design: Randomized Controlled Trial. Settings: Bahawal Victoria Hospital. Period: Feb 2018 to July 2018. Material & Method: A total of 266 patients with primary PPH due to uterine atony of 20 to 39 years of age were enrolled in the study. Patients of primary PPH due to bleeding disorders, ruptured uterus, on anticoagulant therapy and hypersensitivity to prostaglandin were excluded. Patients were divided randomly into two groups i.e. Group A (for intramyometrial injection) & Group B (for intramuscular injection). Outcome variables like arrest of bleeding within 30 minutes after start of treatment (efficacy) were noted for successful or unsuccessful outcome. Results: The mean age of women in group A was 26.94 ± 4.43 and in group B was 26.21 ± 4.09 years (p=0.005). The mean parity in group A was 2.92 ± 0.87 and in group B was 2.93 ± 0.98 (p=0.8579). Efficacy was 82.71% in group A (Intramyometrial group) and 91.73% in group B (Intramuscular group) with p-value of 0.0276. Conclusion: This study concluded that intramuscular prostaglandin F2α has better efficacy i.e. 91.73% in a patient of uterine atony for management of primary PPH as compared to intramyometrial rout of administration for prostaglandin F2α.

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Objective: To evaluate the outcome of the B-Lynch technique as a treatment for postpartum hemorrhage due to intraoperative uterine atony in patients of the Obstetrics and Gynecology Department of the Dr. Miguel Pérez Carreño Hospital. Methods: Descriptive cut study, with a field design, transversal and prospective. The sample consisted of 60 patients who presented intraoperative uterine atony, the B-Lynch technique was applied and they were treated at the Obstetrics and Gynecology Department of the Dr. Miguel Pérez Carreño Hospital, during the period March 2016 - March 2017. Results: Average age of 26 years was evidenced, patients with II pregnancies, gestational age at term and controlled pregnancies predominated, with previous hemoglobin and hematocrit values with a posterior average lower than that before surgery. In 100 % of the cases, the hemorrhagic problem was successfully resolved, with the patients being discharged from the hospital. Conclusion: The B-Lynch technique proved to be an easy, fast and successful procedure in the management of postpartum hemorrhage due to intraoperative uterine atony, which is why its use is recommended. Keywords: B-Lynch, Uterine Atony, Postpartum Hemorrhage, Intraoperative

Effectiveness of the Intrauterine Compression Balloon in Postpartum Hemorrhage, Riobamba Provincial Teaching Hospital – October 2015 to September 2016

Introduction: Postpartum hemorrhage is blood loss greater than 500 mL after a normal delivery or more than 1000 mL after a cesarean section, or any postpartum bleeding regardless of the amount causing hemodynamic instability. The uterine blood flow in a term pregnancy is approximately 500 to 700 mL/min, for this reason, a patient who presents this complication, in a few minutes, can be drained and compromise her life. Objective: To determine the efficacy of the intrauterine compression, balloon in the management of postpartum hemorrhage due to hypotonia or uterine atony, at the General Teaching Provincial Hospital of Riobamba from October 2015 to September 2016. Methodology: The effectiveness of the use of the intrauterine compression balloon after the failure of pharmacological management was analyzed and statistical evaluation was applied to determine the efficacy of this method for the management of this pathology. Results: It was placed in 23 patients who presented postpartum hemorrhage due to hypotonia or uterine atony, and it had an effectiveness of 94.4% after a vaginal delivery and 80% after a cesarean section. Reaffirming that it is an excellent option in the management of this type of complications. Conclusions: Postpartum hemorrhage is the second cause of maternal death nationwide, technical and timely action will help reduce maternal morbidity and mortality that this pathology can present; the use of the intrauterine hydrostatic compression balloon is an excellent alternative prior to the surgical management of this pathology. Keywords: postpartum hemorrhage, uterine bleeding, uterine tamponade with balloon. RESUMEN Introducción: La hemorragia posparto es la pérdida sanguínea mayor de 500 mL luego de un parto normal o más de 1000 mL luego de una cesárea, o cualquier sangrado posparto independientemente de la cantidad que cause inestabilidad hemodinámica. El riego sanguíneo uterino en un embarazo a término es de aproximadamente 500 a 700 mL/min por tal motivo, una paciente que presente esta complicación, en pocos minutos puede quedar exangüe y comprometer si vida. Objetivo: Determinar la eficacia del balón de compresión intrauterino en el manejo de la hemorragia posparto por hipotonía o atonía uterina, en el Hospital Provincial General Docente de Riobamba de Octubre del 2015 a septiembre del 2016. Metodología: Se analizó la efectividad del uso del balón de compresión intrauterina luego del fracaso del manejo farmacológico y se aplicó la evaluación estadística para determinar la eficacia de este método para el manejo de esta patología. Resultados: Se colocó en 23 pacientes que presentaron hemorragia posparto por hipotonía o atonía uterina, y se tuvo una efectividad del 94.4 por ciento luego de un parto vaginal y del 80% luego de una cesárea. Reafirmando que es una excelente opción en el manejo de este tipo de complicaciones. Conclusiones: La hemorragia posparto es la segunda causa de muerte materna a nivel nacional, el accionar técnico y oportuno ayudará a disminuir la morbimortalidad materna que puede presentar esta patología; la utilización del balón de compresión hidrostático intrauterino es una excelente alternativa previo al manejo quirúrgico de esta patología. Palabras clave: hemorragia posparto, hemorragia uterina, taponamiento uterino con balón.

Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study

ObjectivesThis study aims to use the high-quality national monitoring data from the China’s National Maternal Near Miss Surveillance System (NMNMSS) to ascertain the incidence, trends and risk factors of obstetric massive blood transfusion (MBT) from 2012 to 2019 in China and determine its clinical outcomes.SettingsObservational study of hospitalised pregnancies who had given birth or ended their pregnancy among member hospitals of NMNMSS.Participants11 667 406 women were included in this study.Primary and secondary outcome measuresWe screened for the incidence, trends, risk factors and main reasons for obstetric MBT, and the outcomes after obstetric MBT. MBT was defined as the transfusion of ≥5 units of red blood cells or ≥1000 mL of whole blood. The incidence of MBT was defined as the MBT cases per 10 000 pregnancies.ResultsObstetric MBT occurred in 27 626 cases, corresponding to an incidence of 23.68 per 10 000 maternities, which exhibited an increasing trend in China during 2012–2019 (14.03–29.59 per 10 000 maternities, p for trend <0.001). Obstetric MBT was mainly associated with amniotic fluid embolism, uterine atony, abnormal placenta, severe anaemia, ectopic pregnancy, abortion, caesarean section, advanced maternal age and multiparous from biological effect. While from sociological effects, uterine atony, severe anaemia and placenta previa are the top three complications which more likely to undergo obstetric MBT in the Chinese population. Overall, the secular trends of hysterectomy incidence (25.07%–9.92%) and MMR during hospitalisation (21.41‰–7.48‰) among women who underwent MBT showed decreasing trends (p for trend <0.001).ConclusionTo minimise the incidence of obstetric MBT, more attention should be paid to education on the importance of the antenatal visit, evidence-based transfusion practice and females who are multiparous and have an advanced age, amniotic fluid embolism, uterine atony, severe anaemia and placenta previa.

Uterus-Preserving Treatment for Placenta Percreta by Reconstruction of the Lower Uterine Segment Using Wave Compression Suture: A Retrospective Cohort Study

Purpose To observe the hemostatic efficacy of reconstructing the lower uterine segment by wave compression sutures (WCSs) in patients with placenta previa who underwent cesarean section (CS). Methods Retrospective analysis the medical records with placenta previa underwent WCS at the West China Second University Hospital of Sichuan University.One-hundred-and-twenty-three women who received WCSs as the first uterine suture technique from January 1, 2016, to December 31, 2020, were included in this study. The hemostatic effect of WCS was compared according to the type of placenta previa and the intraoperative situation. All patients were followed up after CS. Results The hemostatic effect during CS and postpartum hemorrhage were observed. Seventy-two (58.5%) patients successfully achieved hemostasis without further intervention. Fifty-one (41.5%) cases required additional uterine artery ligation (UAL), cervical hanging maneuver (CHM), and Bakri tamponade. Seventy-nine cases exhibited thin anterior walls and lower uterine atony after placental dissection; of these, 72 (91.1%) obtained hemostasis by WCS. No patient required repeat laparotomy or hysterectomy. There were no complications attributable to the WCS following surgery. Among the five patients who had a second pregnancy, no intrauterine adhesions or abnormal uterine morphologies were caused by WCS. No ectopic or incision pregnancies occurred. Conclusions Reconstruction of the lower uterine segment by WCS is a suitable technique for patients with thin anterior walls and uterine atony of the lower uterine segment along with placenta previa. WCS is easy to perform, effective, and safe.