Bilateral Ligation Research Articles

Neural Therapy Effect and Bilateral Tubal Ligation

Neural Therapy Effect and Bilateral Tubal Ligation

Surgical treatment of postpartum haemorrhage: national survey of French residents of obstetrics and gynecology

BackgroundPostpartum haemorrhage (PPH) is a major cause of maternal morbidity and one of the leading causes of maternal mortality worldwide. Many medical treatments and interventions are available nowadays, but surgical treatment is sometimes required when less invasive methods are unsuccessful. This study aimed to assess the theoretical and practical knowledge of French residents of Obstetrics and Gynecology concerning the surgical treatment of postpartum haemorrhage.Study designWe performed a questionnaire study for senior residents of Obstetrics and Gynecology in France (fourth and fifth year of training). An anonymous survey was sent by email. Between December 2013 and April 2014, a total of 370 residents responded.ResultThe response rate was 47.6% (176/370). Only 156 questionnaires were fully completed and included for analysis. In all, 74% (115/156) of residents reported not mastering sufficiently or at all the technique for bilateral ligation of uterine arteries, 79% (123/156) for uterine compression sutures, 95% (148/156) for ligation of the internal iliac arteries, and 78% (122/156) for emergency peripartum hysterectomy. More than half of respondents (55%, 86/156) stated that they had not mastered any of these techniques.ConclusionAn alarmingly high number of French senior residents in Obstetrics and Gynecology report that they have not acquired the sufficient surgical skills during their training to be able to perform the surgeries required for the management of PPH.

Role of Surgery in the Management of Gestational Trophoblastic Neoplasia

Gestational trophoblastic neoplasia (GTN) is now one of the most curable gynaecologic malignancies owing to effective chemotherapy and sensitive tumour marker β hCG (beta subunit of human chorionic gonadotropin). The objective of this study was to evaluate the role of adjuvant surgical procedures in the management of GTN. A retrospective review was done of available records of all GTN cases managed at our regional cancer centre from 2009 to 2017. Thirteen out of 134 patients required some surgical intervention. The number of surgical procedures done was 15. Of a total of 134 patients, 13 (9.7%) patients required surgical intervention. Thirteen patients underwent 15 surgical procedures. Two patients had more than one surgery—hysterectomy and pulmonary resection. Seven surgical procedures were done for the control of haemorrhage—one emergency hysterectomy with bilateral internal iliac ligation, one internal iliac ligation, two internal iliac embolisation, two uterine artery embolisation, and vaginal sutures in one patient. Six surgeries were done in four patients for excision of chemoresistant disease—hysterectomy in two patients and hysterectomy and pulmonary resection in two patients. Hysterectomy with BPLND was done in a case of PSTT. Small bowel resection and anastomosis were done in one patient with intestinal obstruction. Though chemotherapy is the mainstay of treatment in GTN, surgery may be necessary as a life-saving procedure in case of haemorrhage or to achieve remission in chemoresistant disease. High-risk GTN cases must be managed at tertiary care centres under care of a multidisciplinary team.

Artery Ligation for Infected Femoral Pseudoaneurysms Does Carry a High Risk of Major Amputation

Arterial ligation has been described in the literature as a safe and effective procedure with a relatively low number of patients requiring major amputations. We performed a retrospective analysis of a prospectively held database of all patients who underwent arterial ligation for infected femoral pseudoaneurysms due to chronic intravenous drug abuse from January 2012 to March 2018. Information recorded for each patient included age, gender, blood investigations, microbiologic results, diagnostic modality, operative details, outcome of surgery, postoperative complications, and follow-up. There were 25 patients identified, with 2 of them undergoing bilateral ligations. It was more common in men (4:1), and the mean age at presentation was 39.7years (standard deviation 8.2y). Nine patients underwent major limb amputation for severe limb ischemia (7transfemoral amputations and two 53 hip disarticulation). Average hospital stay was 24days, and there was no mortality. We found a trend with a higher level of arterial ligation, leading to a higher rate of amputation. Our study is the first to show that there is a trend toward a higher risk of amputation with a higher level of ligation in this cohort of patients, and therefore, we suggest avoidance of external iliac artery ligation even at the most distal part just under the ligament, leaving the circumflex iliac vessel in circuit. Arterial ligation also carries a higher risk of major amputation than previously reported.

Clinical profile of patients with uterine rupture at a tertiary facility in North Central Nigeria

Background: Uterine rupture is a major obstetric emergency and an important cause of maternal and perinatal morbidity and mortality. Aim: To determine the prevalence, clinical presentation, management options and pregnancy outcomes following uterine rupture. Methods: It is a 5-year, descriptive, retrospective study of parturients who had uterine rupture between 1 January 2011 and 31 December, 2015, at Federal Medical Centre, Bida, North Central Nigeria. The case files of all parturients who had uterine rupture during this period were retrieved from the Medical Records department, and relevant information including maternal age, risk factors for uterine rupture, presenting symptoms, site of rupture and the definitive treatment as well as maternal and neonatal outcome using a data collection sheet was entered into a computer with SPSS version 20.0, which was also used for the analysis. Results: The prevalence of uterine rupture was 1 in 202 deliveries (48/9,718); of these, 24 (50.0%) were aged 36–40 years and 28 (58.3%) were grandmultipara (parity ≥5); 42 (87.5%) cases had previous uterine scar, whereas 15 (31.3%) had labour augmentation with oxytocin while attempting vaginal birth after caesarean section. The common presenting complaints were intrapartum vaginal bleeding (24; 50%) and abdominal pain (10; 20.8%). The most common site of rupture was anterolateral (24; 50.0%), while the most common surgical intervention was uterine repair with bilateral tubal ligation (30; 62.5%). The case fatality rate was 18.8% (9/48), neonatal survival rate was 12.5% (6/48) and perinatal mortality rate was 875/1000 deliveries (42/48). Conclusion: Uterine rupture remains an important cause of poor pregnancy outcomes in low-income settings. Previous caesarean delivery is the most common risk factor; women attempting vaginal birth after caesarean delivery should be managed by skilled health personnel in facilities with provision for emergency surgical intervention.

Contraceptive Methods: Knowledge, Practice and their Attitude among the Women of Rural Population in and around Bangaluru City of Karnataka State, India

The main objective of this study was to assess the knowledge attitude and practice of contraceptives in rural women. this is across sectional study of rural women between 20–45 age groups attending the Outpatient department of obstetrics & gynaecology at AIMS&RC situated at Devanahalli rural Bengaluru, Karnataka. Methodology-500rural women were interviewed by giving the questionnaire which assesses the KAP of contraception and the various methods like barrier intrauterine contraceptive device, Oral contraceptive Pills’ Tubectomy Vasectomy and injectable contraceptive withdrawal technique and emergency contraception. The socio-demographic characteristics like age, parity, educational status and their income were assessed for the awareness of the various contraceptive methods among the rural women residing in and around Bangalore city of Karnataka state. It was found that 95% women were aware of bilateral tubal ligation, 85% known for condoms and 72% known for IUCD and also other various contraceptive methods. However, lack of knowledge on their usage and attitude to the contraceptive methods, birth control is not reaching its target.

Ligation of Internal Iliac Artery: Educational Video with Basic Steps and Key Points

Internal iliac artery, the pelvic branch of the common iliac artery, supplies the pelvic viscera. Bilateral ligation of the internal iliac artery is often practiced in obstetrics and gynecology as it helps in controlling massive pelvic bleeding. The ligation of this artery just after the posterior division is crucial. In this video, we present a cadaveric dissection, where the distance between the bifurcation of the common iliac artery and the superior gluteal artery was found to be 3.1 cm. The video includes the demonstration of relevant anatomic structures and is aimed at educating the residents and gynecologists regarding the steps and key points to be kept in mind during internal iliac artery ligation.

EFFECT OF UROKINASE GENE-KNOCKOUT ON GROWTH OF MELANOMA IN EXPERIMENT

The purpose of the study was to reveal special features of the В16/F10 melanoma growth in urokinase (uPA) gene knockout mice with and without chronic neurogenic pain (CNP). Material and methods . The study included male and female С57ВL/6 mice (n = 102) and C57BL/6-Plautm1.1BugThisPlauGFDhu/GFDhu mice with uPA gene knockout (n = 48). Mice of the main subgroups underwent subcutaneous transplantation of В16/F10 melanoma 2 weeks after bilateral ligation of sciatic nerves (CNP model); mice of the same strain with standard melanoma transplantation served as controls. Results and discussion . Survival of uPA gene knockout mice did not differ from that of normal animals – 1.5 times higher in females than in males (p < 0.05), with melanoma onset in gene-deficient mice a week earlier. The dynamics of tumor growth had pronounced gender differences: in females, the tumor did not grow and its maximal volume prior to death was 1.0 cm3, while tumors in males were characterized by an active growth with two peaks of volume increase (weeks 2 and 4). Melanoma was weakly metastatic – solitary metastases to the lungs (in females) or no metastases, but pulmonary and heart hemorrhages were noted (in males). CNP decreased the survival of uPA gene knockout females, as well as of normal animals, but did not influence the survival of males; primary tumors in genedeficient mice appeared a few days later than in controls but their growth was more intense, with diminished gender differences. Increased metastasis was manifested by the initiation of metastatic lesions to the lungs and liver in males, with maintained pulmonary hemorrhages, and by increased number of metastatic foci in the lungs together with the appearance of pulmonary hemorrhages in females. Conclusions . The influence of uPA gene knockout on the course of В16/F10 melanoma differs in male and female mice. CNP enhances malignant tumor growth, diminishing gender differences, and activates melanoma metastasis.

Neuroprotective Effect of Oral Administration of Trigonella Foenum-Graecum on Chronic Cerebral Hypoperfusion in Rat Model

Introduction: Decreased cerebral blood supply to the brain can generate a condition of chronic cerebral hypoperfusion, which is one of the pathophysiological mechanisms of neuronal degeneration and cognitive impairment in Alzheimer’s disease. This study aimed to evaluate the potential neuroprotective effects of Trigonella foenum graecum seeds on chronic cerebral hypoperfusion in a rat model. Materials and Methods: Chronic cerebral hypoperfusion was induced by permanent bilateral ligation of the common carotid arteries (a two-vessel occlusion, 2VO) in male Sprague–Dawley rats. The experimental groups were divided into three groups (11 rats/group): i) sham (control) group; ii) 2VO group without any treatment; and iii) 2VO group that was administered orally with the Trigonella foenum graecum extract (100 mg/kg/day) by oral gavage from 3 days before the date of 2VO surgery and continued daily until the end of the 8th postoperative week. Spatial memory performance was assessed by the Morris water maze test. Malondialdehyde and C-reactive protein (CRP) concentration, superoxide dismutase and glutathione activities were measured in serum after 8 weeks from 2VO injury. Results: Chronic cerebral hypoperfusion rats resulted in spatial memory impairments. This behavioral dysfunction was accompanied by decreasing superoxide dismutase and glutathione activities, and increasing malondialdehyde and CRP levels in serum. Oral administration of Trigonella foenum graecum extract significantly improved the memory impairment, enhanced antioxidant enzyme activities, and decreased the malondialdehyde and CRP levels to near normal levels. Conclusion: The potential activity offered by Trigonella foenum graecum extract showed the neuroprotective effect that may be beneficial in cerebrovascular type dementia.

Study on Variations in the Origin and Branching Pattern of Internal Iliac Artery in Cadavers

The variations in blood vessels are common and have long received the attention of anatomists and surgeons. The true pelvic cavity usually refers to that part of pelvis, which has its bony walls, the sacrum and lower part of hip bone. This small area is well covered by bones and has important structures namely the pelvic viscera, pelvic floor muscles, vessels and nerves supplying it. The aim of the study was to know the branching pattern of internal iliac artery based on the Adachis classification, along with length and thickness of artery. The internal iliac artery was traced from its origin, course, branching pattern, length and thickness of the trunk of internal iliac artery was measured by using digital vernier calliper from its point of origin to bifurcation into anterior and posterior division. The length of right &amp; left internal iliac artery ranged from 2.4 cm to 5.4 cm with average length of 3.943cm ± 0.859cm, whereas the length of left internal iliac artery ranged from 2.7cm to 4.7cm with average length of 3.610cm ± 0.626cm. Bilateral ligation of internal iliac artery is helpful in controlling postpartum haemorrhage. Applying ligatures on an anomalous blood vessel may lead to alarming haemorrhage. The most ideal point of ligation of internal iliac artery would be distal to its posterior division, since proximal ligation has been associated with buttock claudication and necrosis. Knowledge regarding the internal iliac artery and its branches is helpful in applying ligatures safely during pelvic surgeries.

Ischemic preconditioning improved renal ischemia/reperfusion injury and hyperglycemia.

Renal ischemia/reperfusion (I/R) is an alternation of renal hemodynamics, which results in diverse postischemic responses and eventually acute kidney injury. Although renal ischemic preconditioning (IPC) is known to protect the kidney from I/R injury, the precise renoprotective mechanisms are not completely understood. The multiple renoprotective effects of IPC underscore the importance in understanding molecular mechanisms and the targets of action involved. This study aimed to identify the biochemical changes in renal I/R injury and investigate the renoprotective mechanisms of IPC. Herein, renal I/R was produced in adult male Sprague-Dawley rats through the bilateral ligation of renal pedicles for 45 min, followed by reperfusion for 24 h. For the IPC group, rats were subjected to three cycles of 2-min ischemia, followed by a 5-min reperfusion, 15 min prior to renal I/R. Our data confirmed the beneficial effects that IPC has on renal I/R injury. IPC-mediated renoprotection was associated with the resolution of oxidative stress, inflammation, apoptosis, and hyperglycemia. Among the numerous signaling molecules involved in the renoprotective mechanisms of IPC, an elevated protein expression of Nrf2, HO-1, LC3 II conversion, along with Atg12 and protein phosphorylation of AMPK, as well as a decreased protein phosphorylation of ERK, p38 MAPK, and Akt and NF-κB DNA binding activity were identified. Importantly, the post renal I/R overproduction of counter-regulatory hormones, impaired hepatic insulin action, and augmented hepatic gluconeogenesis were improved through IPC. As counter-regulatory hormones have been implicated in the induction of oxidative stress, inflammation, apoptosis, impaired insulin action, hyperglycemia, and tissue destruction, our findings suggest that counter-regulatory hormones may well be valuable targets of IPC for combatting renal I/R injury. © 2018 IUBMB Life, 71(3):321-329, 2019.

Application effect of bilateral uterine artery ligation of uterine plasma muscle layer with bilateral uterine artery on postpartum hemorrhage

目的 探讨子宫浆肌层缝扎加双侧子宫动脉上行支结扎对产后出血的治疗效果。 方法 选取2015年8月至2017年8月东阳市人民医院剖宫产术中子宫腔内出血患者120例为研究对象，采用随机数字表法分为对照组(n＝60)、观察组(n＝60)。对照组采用常规止血处理，观察组采用子宫浆肌层缝扎加双侧子宫动脉上行支结扎，对比不同处理方式的止血效果。 结果 观察组止血有效率(100.0%)较对照组(91.7%)高(χ2＝5.217，P＝0.022)；观察组产后出血发生率(8.3%)较对照组(21.7%)低(χ2＝4.183，P＝0.041)；观察组产后出血量[(615.8±34.7)mL]、血性恶露消失时间[(5.1±2.3)d]较对照组[(823.2±41.8)mL]、[(8.1±3.4)d]少、短(t＝29.572，P＝0.000；t＝5.661，P＝0.000)，观察组不良反应发生率(5.0%)与对照组(6.7%)差异无统计学意义(χ2＝0.152，P＝0.697)。 结论 子宫浆肌层缝扎加双侧子宫动脉上行支结扎可达到良好的止血效果。

Expression of c-Jun N-terminal kinase and B cell lymphoma/leukemia-2 associated X protein in rabbit basilar artery aneurysm

Objective To observe the expression of c-Jun N-terminal kinase(JNK) and B cell lymphoma/leukemia-2 associated X protein (bax) during the formation of basilar aneurysm in the rabbit. Methods Forty New Zealand white rabbits were divided into five group, Normal group (n=5), Sham group (n=5) , Operation group(2 weeks, 8 weeks, 16 weeks)(n=10). The bilateral common carotid artery was exposed in the sham operation group by bilateral common carotid artery ligation. MRA (Magnetic Resonance Angiography) was performed at the prescribed time, All experimental animals were killed in order to observe the pathological staining of the basilar artery tip morphology, vascular intima, the middle elastic layer and the immunohistochemical staining. Results The results of immunohistochemical staining showed that the positive rate of JNK in each group was (8.600±2.074)% in the control group, (18.900±4.458)% in the 2W group (t=13.405, P=0.000), and the postoperative 8W group (25.800±3.615)% (t=22.570, P=0.000), postoperative 16W group (38.400±8.343)% (t=14.555, P=0.000); the difference between the experimental group and the control group was statistically significant. The positive expression rates of bax were: (9.400±3.050)% in postoperative 2W group, (22.100±4.748)% in postoperative 2W group (t=14.719, P=0.000) postoperative 8W group (29.200±4.894)% (t=18.866, P=0.000), postoperative 16W group (36.700±4.762)% (t=24.371, P=0.000); each experimental group was statistically significant difference from the control group. Imaging results: aneurysm The volume was: control group (7.600±3.847), (24.746±27.813) mm3,t=2.814, P=0.020), postoperative 8W group (37.083±35.695) mm3 (t=3.285, P=0.009), postoperative 16W group (105.751±97.094) mm3 (t=3.444, P=0.007); the difference between the experimental group and the control group was statistically significant. Conclusion C-Jun N-terminal kinase and bax are involved in the formation of basilar artery aneurysm in rabbits. Key words: Intracranial aneurysm; c-Jun N-terminal kinase; B cell lymphoma/leukemia-2 associated X protein

Comparison of Hysteroscopic Sterilization versus Traditional Bilateral Tubal Ligation and Concomitant Endometrial Ablation with the Development of Post Ablation Tubal Sterilization Syndrome (PATSS)

Comparison of Hysteroscopic Sterilization versus Traditional Bilateral Tubal Ligation and Concomitant Endometrial Ablation with the Development of Post Ablation Tubal Sterilization Syndrome (PATSS)

Protective effect of electroacupuncture preconditioning at zúsānlĭ (足三里 ST36) on mitochondria in the intestinal ischemia/reperfusion injury

ObjectiveThe study explored the effect of applying electroacupuncture (EA) preconditioning at ST 36 on mitochondria in rats with intestinal ischemia/reperfusion injury. MethodsForty SD rats were divided into four sets: sham operation group (sham group); intestinal ischemia/reperfusion group (I/R group); EA preconditioning at ST 36 followed by intestinal ischemia/reperfusion injury (ST 36 + I/R group); EA preconditioning at the lateral site away from ST36 0.5 cm followed by intestinal ischemia/reperfusion injury (N + I/R group). For the sham group, the rats were opened abdominal cavity for 3 h and 20 min and their abdominal cavities were covered with wet gauze avoiding drying and kept on the thermostat at 37 °C. For the ischemia/reperfusion (I/R) group, rats were anaesthetised and their abdominal cavities were opened to expose jejunum segments. The segment's collateral blood supply was restricted by bilateral ligation of the intestine. Next, one of the branches of a mesenteric artery was occluded with a thread for 20 min and then the thread was released after such ischemia conditions, keeping reperfusion for 3 h. For the ST36 + I/R group, the electroacupuncture at ST36 was first performed, then the intestinal ischemia/reperfusion model was constructed. For the N + I/R group, electroacupuncture at non ST36 acupoint, which is away from ST36 about 0.5 cm, and then the intestinal ischemia/reperfusion model was performed. Measurements of the levels of inflammatory markers tumour necrosis factor α (TNFα) and interleukin-1 beta (IL-1β), cytochrome c (CYCS), and the mitochondrial membrane pro-apoptotic protein (BAX), anti-apoptotic protein Bcl-2 were performed. ResultsCompared to I/R group, the intensity of cytoplasmic CYCS in intestinal tissues was significantly decreased in the ST 36 + I/R group (1.65 vs. 0.18, p < 0.05). Compared to N + I/R group, the intensity of cytoplasmic CYCS in intestinal tissues was also dramatically declined in the ST 36 + I/R group (1.37 vs. 0.18, p < 0.05). The level of CYCS in mitochondria in rats in the ST 36 + I/R group were appreciably increased than those of rats in the I/Rgroup (1.42 vs. 0.06, p < 0.05), and CYCS in mitochondria was also largely expressed in ST36 + I/R group than N + I/R group (1.42 vs. 0.08, p < 0.05). Bcl-2 was shown to be elevated in the ST 36 + I/R group than I/R group (1.01 vs. 0.10) and N + I/R group (1.01 vs. 0.09, all p < 0.05), whereas BAX expression was greatly decreased in the ST36 + I/R group than I/R group (0.11 vs. 0.78 ) and N + I/R group (0.11 vs. 0.87, all p < 0.05). ConclusionThe results suggest the EA intervention has a protective effect upon mitochondria, preventing CYCS release and the subsequent activation of downstream apoptosis pathway. It is proposed that patients due to undergo gastrointestinal surgery get benefit from EA preconditioning at ST 36.

Evaluating the role of clinical officers in providing reproductive health services in Kenya

BackgroundMost sub-Saharan African countries have too few reproductive health (RH) specialists, resulting in high RH-related mortality and morbidity. In Kenya, task sharing in RH began in 2002, with the training of clinical officer(s)–reproductive health (CORH). Little is known about them and the extent of their role in the health system.MethodsIn 2016, we conducted a retrospective, quantitative two-stage study in Kenya to evaluate the use of CORH and 28 of their curriculum-derived RH competencies, to determine their contribution to expanded access to RH care. CORH were surveyed, using structured questionnaires and telephone interviews. Data on the frequency with which CORH used specified competencies were collected from health records in selected facilities.ResultsForty-nine of all 104 CORH participated in the survey (47%). Forty-eight (98%) had worked in the clinical area, and 79% were still engaging in clinical work. All 48 worked in emergency obstetrics, emergency gynaecology, and nonemergency RH, and 38 (79%) filled clinical leadership positions. Vasectomy was least performed, by only 9 (18%) CORH. All other competencies were applied by at least half of the CORH, and 22 competencies by more than three quarters. Forty-one (84%) CORH performed caesarean section (CS). Teaching and management were other common responsibilities.Data were collected from 12 facilities and analysed for 11. They generally confirmed the initial survey findings: CORH worked as obstetrics and gynaecology consultants and used most of their competencies. Analysis was based on 118 months of theatre records. CORH made significant contributions to their facility’s capacity to perform RH surgery: most respondents performed at least 25% of these surgeries. They performed an average of six CS per month and more than 25% of perineal tear repairs (33%), uterus repairs (33%), manual placenta removals (26%), bilateral tubal ligations (39%), and cervical cancer staging (27%). Some experienced CORH conducted procedures beyond their training.ConclusionsCORH expand access to emergency RH care. Their contributions span all areas of obstetric and gynaecological care, mentoring new health workers and expanding their scope of practice. However, the generally poor status of records documenting healthcare provision limits their usability in evaluation and research.

Intrauterine Growth Retardation Induced Long-Term Gene Dysregulation Is Associated with Altered Histone Modifications in Rat Islets

Intrauterine growth retardation (IUGR) is associated with the development of type 2 diabetes in adulthood. Although the underlying mechanisms remain unclear, permanent alterations in gene expression implicate epigenetics. Using a rat model of IUGR induced by bilateral uterine artery ligation at e18, we sought to determine if histone modifications are a potential mechanism for permanent IUGR-induced gene dysregulation. We assessed genome-wide histone modifications in islets from 2 and 10 week control and IUGR rats using ChIP-Seq. IUGR induced significant changes in enrichment of H3K4me3, H3K27me3, and H3K27Ac marks in 2 week islets at 2181, 1482, and 4572 annotated genes, respectively. At 10 week there were far more changes in enrichment of these marks (9988, 3489, and 4355 genes, respectively). We then integrated our RNA-Seq transcriptome data obtained at the same ages and found that the expression levels of multiple genes in IUGR islets were correlated with changes in histone marks. In 10 week islets, the expression of 639, 355, and 400 genes correlated with changes in enrichment of H3K4me3, H3K27me3, and H3K27Ac, respectively; whereas in 2 week islets, only 43, 64, and 149 genes were correlated with enrichment of these marks. Interestingly, 6 genes in 10 week islets correlated with changes in all 3 histone marks, strongly suggesting that changes in gene expression were induced by histone modifications. Ingenuity pathway analysis of differential expressed genes that correlated with histone modifications revealed significant enrichment in pathways critical for normal islet function, such as cAMP-mediated signaling, immune function, axonal guidance, and VEGF family ligand-receptor interaction. Collectively, the present findings identify histone modification as a potential epigenetic mechanism that may contribute to long-term gene dysregulation and abnormal islet phenotype in IUGR animals. Disclosure Y. Lien: None. P. Wang: None. R.A. Simmons: None.

External iliac artery thrombosis after hypogastric artery ligation and pelvic packing for placenta previa percreta

Placenta previa percreta is a serious pregnancy condition that may cause massive bleeding. Life-threatening hemorrhage is commonly managed via cesarean hysterectomy or vascular ligations in order to preserve fertility. We present a case of bilateral external iliac artery thrombosis after pelvic compression and uterine devascularization due to placenta previa percreta. The patient had cesarean section due to ultrasonography and magnetic resonance imaging-diagnosed placenta previa percreta, and stated that she preferred a conservative approach rather than hysterectomy in a case of massive bleeding. Spontaneous hemorrhage was recognized during the operation. Pelvic compression and bilateral uterine and internal iliac artery ligations were performed. The left external iliac artery was accidentally held and bonded as the left internal iliac artery, which was turned loose within a minute after distinguishing the vessels. Emergency angiography that was applied because of patient’s leg pain showed bilateral external iliac artery thrombosis. Angioplasty was performed by a cardiologist for bilateral occlusions. Placenta invasion abnormalities may be managed by pelvic compression or vascular ligations, which have their own serious complications that the surgeon must manage immediately.

Validation of noninvasive photoacoustic measurements of sagittal sinus oxyhemoglobin saturation in hypoxic neonatal piglets.

We hypothesize that noninvasive photoacoustic imaging can accurately measure cerebral venous oxyhemoglobin saturation (So2) in a neonatal model of hypoxia-ischemia. In neonatal piglets, which have a skull thickness comparable to that of human neonates, we compared the photoacoustic measurement of sagittal sinus So2 against that measured directly by blood sampling over a wide range of conditions. Systemic hypoxia was produced by decreasing inspired oxygen stepwise (i.e., 100, 21, 19, 17, 15, 14, 13, 12, 11, and 10%) with and without unilateral or bilateral ligation of the common carotid arteries to enhance hypoxia-ischemia. Transcranial photoacoustic sensing enabled us to detect changes in sagittal sinus O2 saturation throughout the tested range of 5-80% without physiologically relevant bias. Despite lower cortical perfusion and higher oxygen extraction in groups with carotid occlusion at equivalent inspired oxygen, photoacoustic measurements successfully provided a robust linear correlation that approached the line of identity with direct blood sample measurements. Receiver-operating characteristic analysis for discriminating So2 <30% showed an area under the curve of 0.84 for the pooled group data, and 0.87, 0.91, and 0.92 for hypoxia alone, hypoxia plus unilateral occlusion, and hypoxia plus bilateral occlusion subgroups, respectively. The detection precision in this critical range was confirmed with sensitivity (87.0%), specificity (86.5%), accuracy (86.8%), positive predictive value (90.5%), and negative predictive value (81.8%) in the combined dataset. These results validate the capability of photoacoustic sensing technology to accurately monitor sagittal sinus So2 noninvasively over a wide range and support its use for early detection of neonatal hypoxia-ischemia. NEW & NOTEWORTHY We present data to validate the noninvasive photoacoustic measurement of sagittal sinus oxyhemoglobin saturation. In particular, this paper demonstrates the robustness of this methodology during a wide range of hemodynamic and physiological changes induced by the stepwise decrease of fractional inspired oxygen to produce hypoxia and by unilateral and bilateral ligation of the common carotid arteries preceding hypoxia to produce hypoxia-ischemia. This technique may be useful for diagnosing risk of neonatal hypoxic-ischemic encephalopathy.

Female Sterilization by Tubal Ligation During C-Section in Women with a History of 2 or More C-Section

Objective: The aim of this study is to determine bilateral tubal ligation incidence performed during C-section in women with a history of 2 or more C-section and the factors affecting sterilization demand.Study Design: Patients who were admitted to Zekai Tahir Burak Woman's Health, Education and Research Hospital between February 2017 and June 2017 and who had a history of 2 or more C-section between week 37 and 41 were included in this prospective cross-sectional study. These subjects were separated into 2 groups according to whether they wanted bilateral tubal ligation during C-section. Bilateral tubal ligation was performed by means of modified Pomeroy technique. Both groups were compared in terms of age, gravida, number of children living at home, education level and income status. Patients who did not want bilateral tubal ligation were asked to fill a questionnaire involving reasons for not asking for bilateral tubal ligation.Results: The number of patients who wanted bilateral tubal ligation was 51 (43%) while those who did not want bilateral tubal ligation was 67 (57%). Compared with patients who did not want bilateral tubal ligation, patients who wanted bilateral tubal ligation had more number of children at home and a higher number of previous C-section (p&lt;0.001). Reasons for not wanting bilateral tubal ligation consisted of religious beliefs (26.8%), desire for protection with a reversible contraceptive method (17.9%), partner who does not want bilateral tubal ligation (17.9%), incompletely family size (13.4%), respectively according to their frequency.Conclusion: bilateral tubal ligation for contraception during C-section was performed forty-three percent of women who had had a history of 2 or more C-section. In one fourth of the cases, pregnant women did not want bilateral tubal ligation due to religious beliefs.