Blood-Conservation Strategies in a Blood-Refusal Parturient with Placenta Previa and Placenta Percreta

We present a 35-year-old, gravida 3, para 1, Jehovah’s Witness at 35 weeks of gestation with placenta percreta, who underwent cesarean delivery and delayed hysterectomy. A multidisciplinary team developed a plan, including the use of perioperative erythropoietin and IV iron dextran, intraoperative acute normovolemic hemodilution, cell salvage, tranexamic acid, and uterine artery embolization. This strategy was successful in avoiding the need for allogeneic transfusion and ensuring an uneventful recovery after both surgical procedures.
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

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AbstractPurposePernicious placenta previa induces severe hemorrhage during cesarean section. Abdominal aorta balloon occlusion (AABO) is considered as an effective operation for patients with pernicious placenta previa. The aim of this study was to investigate the clinical application of abdominal aortic balloon occlusion in the placenta previa and cesarean section by systematic review and meta-analysis.MethodsMEDLINE, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WAN-FANG DATA and CQVIP were searched from inception to Jan. 15th, 2019. Operative time, intraoperative blood loss vo...
Source: Archives of Gynecology and Obstetrics - Category: OBGYN Source Type: research
AbstractPurpose of studyAdvanced uterovaginal prolapse can significantly affect the quality of life in women and usually requires surgical management. McCall ’s culdoplasty (M) or sacrospinous fixation (SSF) are done at the time of vaginal hysterectomy with pelvic floor repair (VHPFR) to reduce recurrence, but recurrence rates of 15% and 33% have been reported with these procedures respectively. We hypothesize that combining VH-PFR with both McCall’s culdoplasty and sacrospinous fixation (VH-PFR-M-SSF) may decrease recurrence rates compared to VH-PFR-M without significantly affecting other perioperative outcome...
Source: The Journal of Obstetrics and Gynecology of India - Category: OBGYN Source Type: research
CONCLUSIONS: Endometrial resection and ablation offers an alternative to hysterectomy as a surgical treatment for heavy menstrual bleeding. Both procedures are effective, and satisfaction rates are high. Although hysterectomy offers permanent and immediate relief from heavy menstrual bleeding, it is associated with a longer operating time and recovery period. Hysterectomy also has higher rates of postoperative complications such as sepsis, blood transfusion and haematoma (vault and wound). The initial cost of endometrial destruction is lower than that of hysterectomy but, because retreatment is often necessary, the cost di...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
(Am J Obstet Gynecol. 2018;219(4):405.e1–405.e7.) In the United States, maternal morbidity and mortality are growing public health concerns, with severe maternal morbidity (SMM) affecting>50,000 women in 2014. SMM includes renal failure, shock, sepsis, blood transfusion, and peripartum hysterectomy. Hypertensive disorders of pregnancy are strongly associated with maternal morbidity and mortality and are often responsive to intervention. The primary objective of this study was to evaluate the association between preeclampsia with severe features and SMM at a regional perinatal referral center. They hypothesized th...
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research
This study aimed to investigate the risk of TOLAC resulting in CD based on cervical dilation during labor for the first CD as well as the indication for the first CD.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research
ConclusionBIL surgery can be an effective procedure for handling high-risk obstetric hemorrhage in addition to the chances of future fertility through the preservation of uteri.
Source: The Journal of Obstetrics and Gynecology of India - Category: OBGYN Source Type: research
Authors: Mohan B, Wander G, Bansal R, Mutti J, Tandon P, Juneja S, Puri S Abstract Patients of abnormally invasive placenta (AIP) undergoing caesarean delivery are at increased risk of haemorrhage. Conventional management includes piecemeal removal of placenta or placenta left in situ. However, they often require hysterectomy after delivery. Post-delivery prophylactic uterine artery embolisation (UAE) can help reduce morbidity and preserve fertility. We created an adjoining operating theatre and catheter lab (OT/CL complex). This is a retrospective case control study in which 37 patients of AIP were evaluated. Sixt...
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research
ConclusionMultiple clinical features are associated with the presence of a uterine sarcoma, but when incorporated into a prediction model, they fail to provide significantly more information about women who may have an unrecognized sarcoma and only marginally improve the certainty about women who are not likely to have sarcoma.
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
CONCLUSION: Though only modestly, the rates of the composite neonatal and maternal adverse outcomes increase, from 39 through 41 weeks of gestation, among low-risk parous women. PMID: 31306312 [PubMed - as supplied by publisher]
Source: Obstetrics and Gynecology - Category: OBGYN Authors: Tags: Obstet Gynecol Source Type: research
Conclusions In this study, prophylactic uterine artery catheterization with temporary occlusion of blood flow proved to be a safe technique with low fetal mortality, no maternal mortality, and a low rate of blood transfusion and can be considered an important and effective therapeutic strategy for reduction of maternal morbi dity and mortality, especially in pregnant women with anomalous placental attachment. Furthermore, the possibility of uterine preservation with the use of this method is an excellent contribution to therapeutic management of this group of patients. However, randomized clinical trials are needed to e va...
Source: Jornal Vascular Brasileiro - Category: Surgery Source Type: research
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