Effect of a Combined Hemostatic Technique during Cesarean Section in Placenta Previa

Abstract

Objective: Only a few methods, besides cesarean hysterectomy, are available for controlling intractable bleeding in placenta previa. We aimed to evaluate the effect of the combined hemostatic technique during cesarean section for placenta previa. Methods: We retrospectively reviewed all cesarean deliveries for placental previa performed from April 2013 to December 2018 at Jeonbuk National University Hospital. Medical records were reviewed to determine the amount of red blood cell transfusion, degree of blood loss, and incidence of postpartum hysterectomy and uterine artery embolization between the conventional method and combined technique. Conventional hemostatic technique group undergo usual cesarean section surgery, and combined hemostatic technique comprises temporary bilateral ovarian artery clamping, bilateral uterine artery ligation, and intrauterine Bakri balloon (Cook Medical, Bloomington, IN, USA) tamponade. Results: There were 135 cesarean deliveries for placenta previa during the study period (conventional hemostatic method, n=100; combined hemostatic technique, n=35). The index of blood loss (conventional vs. combined, 0.22±}0.13 vs. 0.22±}0.11, P=0.90) was not different between the two groups. However, the mean amount of intraoperative red blood cell transfusion (0.88±}2.12 vs. 0.55±}0.93 units, P=0.02) was significantly lower in the combined technique group. The incidence of postpartum hysterectomies (5 vs. 0, P=0.025) and postpartum treatments (13 vs. 0, P=0.006) for continuous bleeding after cesarean section was also significantly lower in the combined technique group. Conclusion: Our findings suggest that combined hemostatic technique is associated with less intraoperative red blood cell transfusion and a decreased rate of postpartum hysterectomy and additional hemostatic procedures after cesarean section for placenta previa.