Cesarean Section For Placenta Previa Research Articles

Clinico-Demographic Profile and Pregnancy Outcome in Placenta Previa: A Study from Tertiary Care Hospital

Introduction: Placenta previa is an obstetric complication which causes considerable maternal and fetal morbidity and mortality during pregnancy. This study is done with the objective to find out the clinico-demographic factors associated with placenta previa and to analyze maternal and perinatal outcome in these cases.
 Methods: This was a retrospective study done in the department of Obstetrics and Gynecology of Nepalgunj Medical College Teaching Hospital, Nepalgunj, a tertiary care hospital from Midwestern Nepal. Relevant data were retrieved from maternity register from June 2015 to May 2017. All women who had undergone caesarean section for placenta previa were included in this study.
 Result: Out of total 5812 deliveries during the study period there were 50 caesarian sections done for placenta previa which is 0.86% of total deliveries. Maximum number of mothers belonged to 26- 30 years of age group. Commonest type of placenta previa was minor type. About 72% were multiparous. 20% had previous LSCS and 24% had previous abortion. Postpartum hemorrhage was present in 36% mothers and 32% received blood transfusion. About 64% new born were preterm and low birth weight. 34% babies had less than 7 apgar score at 5 min. Still births were 6%.
 Conclusion: Placenta previa poses greater risk and need of blood transfusion to mother as well as birth of preterm and low birth weight babies which leads to perinatal morbidity and mortality. Timely diagnosis, regular antenatal check up and effective management may improve pregnancy outcome.

Effect of routine rapid insertion of Bakri balloon tamponade on reducing hemorrhage from placenta previa during and after cesarean section.

To evaluate the effectiveness of routine rapid insertion of a Bakri balloon during cesarean section for placenta previa based on a retrospective control study. Women with singleton pregnancies who underwent cesarean section for placenta previa at our institution between 2003 and 2016 were enrolled. Between 2015 and 2016, women who routinely underwent balloon tamponade during cesarean section were defined as the balloon group. Between 2003 and 2014, women who underwent no hemostatic procedures except balloon tamponade were defined as the non-balloon group. The clinical outcomes of the two groups were retrospectively analyzed. Of the 266 women with placenta previa, 50 were in the balloon group and 216 were in the non-balloon group. The bleeding amounts were significantly smaller in the balloon group than in the non-balloon group: intraoperative bleeding (991 vs. 1250g, p<0.01), postoperative bleeding (62 vs. 150g, p<0.01), and total bleeding (1066 vs. 1451g, p<0.01). Furthermore, the mean surgical duration was shorter in the balloon group than the non-balloon group (30 vs. 50min, p<0.01). In the balloon group, five patients suffered from increasing hemorrhage due to prolapse of the balloon from the uterus after the operation, but the hemorrhage was controlled by balloon re-insertion without additional hemostatic procedures. This study demonstrated that the routine rapid insertion of Bakri balloon tamponade during cesarean section significantly decreased intra- and postoperative hemorrhage and shortened the surgical duration in women with placenta previa.

Study on Maternal and Immediate Fetal outcome of placenta previa

Aims: This study aimed to analyze the demographic profile, maternal and fetal outcome of placenta previa.Methods: This was a retrospective study done at Patan Academy of Health Sciences. The study population comprised of all the patients that had caesarean section for placenta previa from April 2012 to October 2015. All patients diagnosed with placenta previa clinically, ultrasonograph or incidentally during caesarean sections were recruited in this study. The data were obtained from medical records and hospital database system. Individual charts were reviewed and data on various parameters were collected.Results: In Patan hospital, there were total 126 placenta previa cases out of 21,552 deliveries during the two and half year period hence the incidence was 0.58 %. We were able to retrieve patient records of only 108 of 126 cases. The incidence of placenta previa was higher with increasing maternal age ≥30 years (41.67%), more common in multigravida (65.74%). We found that associated risks factors included previous CS, multiparity and dilatation and curettage (40.74%). Eleven patients required blood transfusion, seven of them had blood loss of 1000-1400 ml, one had blood loss of 2000 ml. Also, Caesarean hysterectomy were performed in two patients. In term of fetal outcomes, 37.04% were preterm birth and 29.63% of the babies had low birth weight. There was one incident of congenital anomaly, one intrauterine fetal death and six neonatal deaths.Conclusions: Placenta previa is an obstetrics complication that is potentially life threatening to both the mother and the baby.

Intraoperative aortic balloon occlusion in patients with placenta previa and/or placenta accreta: a retrospective study

ObjectiveTo introduce the primary experience of using aortic balloon catheters during cesarean section for placenta previa and/or placenta accreta. Materials and MethodsFrom January 2013 to May 2015, 43 patients who were preoperatively diagnosed with major placenta previa and/or placenta accreta and who underwent prophylactic aortic catheterization before caesarean section (CS) were included in the study. We analyzed the clinical data of the study population. Surgery- and catheterization-related complications were also reported. ResultsMajor placenta previa or placenta accreta was surgically confirmed in 42 patients, 28 of whom had both conditions. The mean patient age was 32.3 ± 5.5 years, whereas the median gestational age at delivery was 260 (range, 153–280) days. Twenty-nine (67.4%) patients had previously undergone CS, and 13 (30%) patients had undergone emergency surgery for antenatal hemorrhage. The median estimated blood loss during surgery was 500 (range, 100–3,000) mL, and the median duration of occlusion was 20 (range, 5–32) minutes. Hysterectomy was performed in five (11.6%) patients and uterine artery embolization in two (4.6%) patients. Two patients with placenta percreta experienced surgery-related complications, and two patients required hospital readmission. No major catheterization-related complications were observed. Forty-two live births were recorded, and the Apgar score of the infants at 5 minutes was > 7. ConclusionIntraoperative aortic balloon occlusion is a relatively safe method for treating placenta previa and/or placenta accreta during scheduled and emergency CS and might be helpful to prevent hysterectomy and embolization in women wishing to preserve fertility.

Double-balloon tamponade used to control postpartum hemorrhage due to placenta previa and/or placenta accreta

Objectives: This study aimed to evaluate the success rate of double-balloon tamponade for managing postpartum hemorrhage originating from the lower segment of the uterus. Materials and Methods: A total of 112 patients underwent an elective cesarean section for placenta previa and/or placenta accreta in Hebei Genaral Hospital from January 2012 to December 2016. The double-balloon tamponade was applied when the standard medical treatment could not control the postpartum hemorrhage originating from the lower uterine segment and blood loss exceeded 1000 mL. Results: A total of 39 patients (34.8%) required the double-balloon tamponade to manage the postpartum bleeding from the lower uterine segment. The mean bleeding during the operation was 1983.9 ± 512.2 mL in the patients who used the double-balloon tamponade. The overall success rate of the double-balloon tamponade in this study was 97.4% (38/39), and no case of hysterectomy was reported. Conclusion: The double-balloon tamponade is a safe, effective, easy, and practical technique. It can successfully control severe postpartum hemorrhage from the lower uterine segment due to placenta previa and/or placenta accreta.

Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients.

PurposeThe aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation.MethodsWe reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL.ResultsSixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20–1200 mL) in the balloon failure group and 60 mL (5–500 mL) in the balloon success group (p<0.01).ConclusionIntrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.

腹腔鏡下に診断治療した腹腔内遊離子宮筋腫の1例

Uterine leiomyomas are commonly encountered benign gynecologic tumors. However, cases of extrauterine leiomyomas are relatively rare and often present diagnostic challenges. We report a case of an acute abdomen caused by an extrauterine leiomyoma that was completely isolated from other organs and was laparoscopically diagnosed. A 39-year-old woman gravida 4 para 4 with a history of a fist-sized uterine myoma at the age of 30 years, was admitted to our hospital because of the acute onset of right lower abdominal pain. The patient had undergone a cesarean section for placenta previa six days before admission. Transvaginal ultrasound revealed a 7.3 × 6.1 cm solid tumor and the physical examination revealed tenderness at the right lower abdomen. Torsion of a subserosal leiomyoma or right ovarian tumor was suspected; therefore, laparoscopic surgery was performed for diagnosis and treatment. Both adnexa were found to be normal-sized, and a tumor completely isolated from surrounding structures was observed. The postoperative histopathologic diagnosis was leiomyoma. Cases of parasitic leiomyomas after laparoscopic myomectomy associated with morcellation are increasingly being reported. In contrast, cases of spontaneous parasitic leiomyomas remain extremely rare because the origins of the tumors are unknown. This case was considered to be a pedunculated subserosal myoma that had spontaneously separated from the uterus and was found prior to parasitization to other organs. Therefore, this case demonstrates a natural pathogenic mechanism of a spontaneous parasitic leiomyoma.

Calculating probability of requiring allogeneic blood transfusion using three preoperative risk factors on cesarean section for placenta previa.

To construct a model to calculating probability of requiring allogeneic blood transfusion on cesarean section (CS) for placenta previa (PP). A retrospective cohort study involving all 205 patients with PP who underwent CS in our institute. We determined the relationship between allogeneic blood transfusion and nine preoperative factors: (1) maternal age, (2) parity, (3) uterine myoma, (4) previous CS, (5) the placenta covering the previous CS scar (referred to as "scar covering"), (6) degree of previa, (7) ultrasound finding of lacunae, (8) preoperative anemia, and (9) preparation of autologous blood. Independent risk factors of allogeneic blood transfusion were identified by multivariate logistic regression analysis. These significant factors were included in the final model, and, the probability of allogeneic blood transfusion was calculated. Independent risk factors of allogeneic blood transfusion were scar covering, previous CS without scar covering, and lacunae. These three factors were used to create a predictive model. The model revealed that patients with scar covering and lacunae had the highest probability (0.73), while those with no risk factors had the lowest probability (0.02). This simple model may be useful to calculate probability of requiring allogeneic blood transfusion on CS for placenta previa.

Anterior placentation as a risk factor for massive hemorrhage during cesarean section in patients with placenta previa.

In placenta previa (PP), anterior placentation, compared with posterior placentation, is reported to more frequently cause massive hemorrhage during cesarean section (CS). Whether this is due to the high incidence of placenta accreta, previous CS, or a transplacental approach in anterior placenta is unclear. We attempted to clarify this issue. We retrospectively analyzed the relation between the bleeding amount during CS for PP and various factors that may cause massive hemorrhage (>2400 mL) (n = 205) in a tertiary center. If the preoperatively ultrasound-measured distance from the internal cervical ostium to the placental edge was longer in the uterine anterior wall than in the posterior wall, we defined it as anterior previa, and vice versa. Patients with accreta, previous CS, total previa, and anterior placentation bled significantly more than their counterparts. Multivariate logistic regression analysis showed that accreta (odds ratio [OR] 12.6), previous CS (OR 4.7), total previa (OR 4.1), and anterior placentation (OR 3.5) were independent risk factors of massive hemorrhage. Anterior placentation, namely, the placenta with a longer os-placental edge distance in the anterior wall than in the posterior wall, was a risk of massive hemorrhage during CS for PP.

A novel ‘uterine sandwich’ for haemorrhage at caesarean section for placenta praevia

Although massive haemorrhage at caesarean section (CS) for placenta praevia is a serious concern, effective treatment is not yet determined. We performed a new uterine sandwich to achieve haemostasis at CS for total placenta praevia in five consecutive cases in whom the placenta reached up to >5cm from the internal cervical os in all directions of an uterine wall. A Matsubara-Yano (MY) uterine compression suture was placed, followed by placement of an intrauterine balloon. Haemostasis was achieved in all five cases with median blood loss of 1618mL. No short-term adverse events were observed. The MY sandwich can be used to achieve haemostasis at CS for placenta praevia.

Evaluation of Complications and Anesthesia Practice in Cases with Cesarean Section for Placenta Previa

Background: It is reported that preterm births related to placenta previa increase perinatal mortality.

Maternal and Fetal outcome in Third Trimesters Bleeding

Objective To evaluate clinical profile, maternal and foetal outcome in third trimester bleeding with the aim to reduce maternal and foetal morbidity and mortality in future. Methods – It is prospective and descriptive study from 1 st February to 30 November 2012. Study included all cases of Third trimester bleeding (134 cases) in which 76 Live Birth, 58 Perinatal Mortality and 2 Maternal Mortality. Clinical features, complications and maternal mortality were evaluated. Data was analysed as percentage of total cases studied. Results –Incidence of third trimester bleeding was 1 in 144 deliveries, being higher with increased age and parity. Most common risk factor is previous caesarean section for placenta previa and hypertension for abruption placentae. Maternal mortality was 1.49% and perinatal mortality was 43.28%.Conclusion –Abruptio placenta and placenta previa remain important causes of perinatal mortality and maternal mortality in third trimester bleeding.

Maternal and neonatal outcomes of placenta previa and placenta accreta: three years of experience with a two-consultant approach.

ObjectiveThe aim of this retrospective cohort study was to evaluate maternal and neonatal outcomes in patients with placenta previa (PP) and placenta accreta (PA).MethodsThe study population comprised all patients who had a cesarean section for PP and PA at a tertiary referral hospital in Taif, Kingdom of Saudi Arabia, from December 2009 to December 2012. Maternal and neonatal data were obtained from medical records and the hospital database system. PA cases were managed by a multispeciality team, including two obstetric consultants.ResultsIn total, 122 patients with PP were identified, with PA found in 25 cases. The median intraoperative blood loss in cases of PA was 2,000 (mean 3,000) mL, with a loss of ≥2,000 mL occurring in 72%, and ≥5,000 mL in 20%. The median packed red blood cell transfusion requirement was 6 (mean 7.7) units, and 28% received ≥10 units. Fetal growth restriction was diagnosed in two cases with known maternal medical disorders. Four cases (3.3%) were diagnosed as small for gestational age. The mean birth weight of the neonates was at the 10th–50th percentile according to Hadlock fetal growth charts.ConclusionThe presence of a second obstetric consultant among the multispeciality team during surgery for PA was associated with a reduction in blood loss and a decreased need for large-volume blood transfusion. The rate of fetal growth restriction/small for gestational age in PP was average, but the babies were relatively small (level 2 evidence).

Obstetric factors and pregnancy outcome in placenta previa

Introduction: Placenta previa is one of the major causes for maternal morbidity and mortality. The aim of this study was to analyze the obstetrical factors associated with placenta previa and to find out the maternal and perinatal outcome of these cases. Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology of TUTH. Hospital chart records of four years (1st January 2008 to 31st December 2011) were collected. Chart records of all women who had undergone cesarean section for placenta previa were reviewed. Relevant clinical findings were noted. Results: During the study period, there were 82 cases of cesarean sections done for placenta previa, which is 0.55% of the total deliveries. Of the eighty two cases, charts could be obtained of the 70 patients for the analysis. 21.4% had total placenta previa. Maximum women were in age group 26-30 years. Sixty one percent of the patients were multipara. Sixteen patients had history of cesarean section and 20 cases had abortions in previous pregnancy. Malpresentation was present in more than one fifth (21.4%) of the patient. 45.7% of the babies were preterm and 27% were low birth weight babies. Seven babies had neonatal death. Almost one third (31.4%) of the patient had blood loss &ge;500ml. There were four cases with blood loss &ge;1000ml. Among them two had loss of more than two liters. Ten patients required blood transfusion. One patient had cesarean hysterectomy. Conclusion: Placenta previa poses danger to both the mother and the baby. There is high maternal morbidity and adverse perinatal outcome. DOI: http://dx.doi.org/10.3126/joim.v34i2.9053 &nbsp; Journal of Institute of Medicine August, 2012; 34:2 38-41

Obstetric factors and pregnancy outcome in placenta previa

Introduction: Placenta previa is one of the major causes for maternal morbidity and mortality. The aim of this study was to analyze the obstetrical factors associated with placenta previa and to find out the maternal and perinatal outcome of these cases. Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology of TUTH. Hospital chart records of four years (1st January 2008 to 31st December 2011) were collected. Chart records of all women who had undergone cesarean section for placenta previa were reviewed. Relevant clinical findings were noted. Results: During the study period, there were 82 cases of cesarean sections done for placenta previa, which is 0.55% of the total deliveries. Of the eighty two cases, charts could be obtained of the 70 patients for the analysis. 21.4% had total placenta previa. Maximum women were in age group 26-30 years. Sixty one percent of the patients were multipara. Sixteen patients had history of cesarean section and 20 cases had abortions in previous pregnancy. Malpresentation was present in more than one fifth (21.4%) of the patient. 45.7% of the babies were preterm and 27% were low birth weight babies. Seven babies had neonatal death. Almost one third (31.4%) of the patient had blood loss ≥500ml. There were four cases with blood loss ≥1000ml. Among them two had loss of more than two liters. Ten patients required blood transfusion. One patient had cesarean hysterectomy. Conclusion: Placenta previa poses danger to both the mother and the baby. There is high maternal morbidity and adverse perinatal outcome. DOI: http://dx.doi.org/10.3126/joim.v34i2.9053 Journal of Institute of Medicine August, 2012; 34:2 38-41

Practical consideration of inserting intrauterine balloon during cesarean section for placenta previa

Practical consideration of inserting intrauterine balloon during cesarean section for placenta previa

Intensive care unit admission of obstetric cases: a single centre experience with contemporary update

OBJECTIVES. To review the characteristics of a series of obstetric patients admitted to the intensive care unit in a regional hospital in 2006-2010, to compare them with those of a similar series reported from the same hospital in 1989-1995 and a series reported from another regional hospital in 1998-2007. DESIGN. Retrospective case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Obstetric patients admitted to the Intensive Care Unit of Kwong Wah Hospital from 1 January 2006 to 31 December 2010. RESULTS. From 2006 to 2010, there were 67 such patients admitted to the intensive care unit (0.23% of total maternities and 2.34% of total intensive care unit admission), which was a higher incidence than reported in two other local studies. As in the latter studies, the majority were admitted postpartum (n=65, 97%), with postpartum haemorrhage (n=39, 58%) being the commonest cause followed by pre-eclampsia/eclampsia (n=17, 25%). In the current study, significantly more patients had had elective caesarean sections for placenta praevia but fewer had had a hysterectomy. The duration of intensive care unit stay was shorter (mean, 1.8 days) with fewer invasive procedures performed than in the two previous studies, but maternal and neonatal mortality was similar (3% and 6%, respectively). CONCLUSION. Postpartum haemorrhage and pregnancy-induced hypertension were still the most common reasons for intensive care unit admission. There was an increasing trend of intensive care unit admissions following elective caesarean section for placenta praevia and for early aggressive intervention of pre-eclampsia. Maternal mortality remained low but had not decreased. The intensive care unit admission rate by itself might not be a helpful indicator of obstetric performance.

Intraoperative aorta balloon occlusion: fertility preservation in patients with placenta previa accreta/increta

Objective: To evaluate whether aorta balloon occlusion decreases the rate of hysterectomies and maternal morbidity during extirpative surgery of placenta previa accreta or increta. Methods: We prospectively assessed 33 consecutive patients with placenta praevia and MRI diagnosis of multifocal accreta or increta. Manual removal of the placenta was performed during a scheduled caesarean delivery. In 15 patients, surgery was preceded by balloon catheterization of the abdominal aorta (Intra Abdominal Balloon Occlusion: IABO); 18 patients refusing IABO were considered as controls. We used Fisher’s exact test for categorical variables and Mann–Whitney test for continuous variables. Results: In the IABO group we observed significant decreases in incidence of hysterectomy, estimated blood loss, number of transfused units of red blood cells, postoperative stay and admission to Intensive Care Unit. No IABO-related complications were reported. Conclusions: During scheduled caesarean section for placenta previa multifocally accreta or increta, IABO can prevent hysterectomy in many cases and improves perioperative outcome as it gives the operator time to achieve the haemostasis via curettage and oversewing of the implantation site with acceptable blood loss.

Obstetric factors and pregnancy outcome in placenta previa

Introduction: Placenta previa is one of the major causes for maternal morbidity and mortality. The aim of this study was to analyze the obstetrical factors associated with placenta previa and to find out the maternal and perinatal outcome of these cases. Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology of TUTH. Hospital chart records of four years (1st January 2008 to 31st December 2011) were collected. Chart records of all women who had undergone cesarean section for placenta previa were reviewed. Relevant clinical findings were noted. Results: During the study period, there were 82 cases of cesarean sections done for placenta previa, which is 0.55% of the total deliveries. Of the eighty two cases, charts could be obtained of the 70 patients for the analysis. 21.4% had total placenta previa. Maximum women were in age group 26-30 years. Sixty one percent of the patients were multipara. Sixteen patients had history of cesarean section and 20 cases had abortions in previous pregnancy. Malpresentation was present in more than one fifth (21.4%) of the patient. 45.7% of the babies were preterm and 27% were low birth weight babies. Seven babies had neonatal death. Almost one third (31.4%) of the patient had blood loss ≥500ml. There were four cases with blood loss ≥1000ml. Among them two had loss of more than two liters. Ten patients required blood transfusion. One patient had cesarean hysterectomy. Conclusion: Placenta previa poses danger to both the mother and the baby. There is high maternal morbidity and adverse perinatal outcome.

Nécrose utérine après embolisation pelvienne pour hémorragie du postpartum : à propos d’un cas

We report a case of uterine necrosis in a 38 year-old patient, who underwent a caesarean section for placenta praevia and an embolisation of the uterine arteries for postpartum haemorrhage. The pelvic embolisation was performed with absorbable gelatine sponge pledgets. This woman presented with abdominal pain and fever three weeks after delivery and a computed tomography scan revealed the presence of gas in the myometrium and endometrium and allowed the diagnosis of uterine necrosis. A total abdominal hysterectomy was performed with adnexal conservation and the diagnosis of uterine necrosis was confirmed histologically. The complications of pelvic embolization and the risks of surgical procedures for the management of intractable obstetric hemorrhage are described.