Massive Obstetric Haemorrhage Research Articles

INTRAUTERINE BALLOON TAMPONADE AS AN EFFECTIVE METHOD OF CONSERVATIVE TREATMENT OF POSTPARTUM BLEEDING

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide and accounts for approximately a quarter of all maternal deaths today. In May 2021, the World Health Organization (WHO) published updated recommendations that intrauterine balloon tamponade is an effective treatment for postpartum hemorrhage when first-line treatment is ineffective. The implementation of balloon intrauterine tamponade during postpartum hemorrhage after cesarean section appears to be safe and effective, which contributes to the reduction of both invasive procedures and the frequency of transfusions. Objective of the study To evaluate the effectiveness of the complex treatment of hypotonic postpartum hemorrhage and bleeding with placental abruption or placentaaccreta during cesarean section by using intrauterine balloon tamponade to prevent periportal hysterectomy. Methods An analysis of 30 cases of postpartum bleeding, which were treated with intrauterine balloon tamponade (IBT), and ended with effective conservative treatment without hysterectomy, was conducted. Research results and their discussion Parity of childbirth is important as a risk factor for the occurrence of hypotonic bleeding. A stretched uterus due to a large fetus was present in 4 (13.3%), twins - in 3 (10%), polyhydramnios - in 2 (6.6%), that is, every third woman had such a risk factor for bleeding. The course of childbirth plays an important role in the exhaustion of the contractile activity of the uterus and the occurrence of postpartum bleeding. Massive obstetric bleeding was more than 1.5% of the weight in 3 (13.6%) women, up to 1.5% in 17 (77.2%), up to 1% in 2 (9.2%). Intrauterine balloon tamponade was performed for the treatment of PPK after ineffective first-line measures. According to our data, finding an intrauterine balloon gradually stopped the bleeding. 1 hour after UBT of the uterus, the amount of blood loss decreased to 400 ml per hour, gradually decreasing to 4-6 hours. After 6 hours of VBT being in the uterus, the bleeding was stopped and the volume of circulating blood was restored. Conclusions Thus, women who have a history of massive postpartum bleeding, multiparous women, pregnant women with a stretched uterus due to a large fetus, multiple pregnancy, women who give birth with a violation of the contractile activity of the uterus are a risk group for the occurrence of postpartum bleeding. Intrauterine balloon tamponade is an effective method of conservative treatment of postpartum bleeding, which should be widely used in obstetric practice.

Emergencies in obstetric anaesthesia: a narrative review.

We conducted a narrative review in six areas of obstetric emergencies: category-1 caesarean section; difficult and failed airway; massive obstetric haemorrhage; hypertensive crisis; emergencies related to neuraxial anaesthesia; and maternal cardiac arrest. These areas represent significant research published within the last five years, with emphasis on large multicentre randomised trials, national or international practice guidelines and recommendations from major professional societies. Key topics discussed: prevention and management of failed neuraxial technique; role of high-flow nasal oxygenation and choice of neuromuscular drug in obstetric patients; prevention of accidental awareness during general anaesthesia; management of the difficult and failed obstetric airway; current perspectives on the use of tranexamic acid, fibrinogen concentrate and cell salvage; guidance on neuraxial placement in a thrombocytopenic obstetric patient; management of neuraxial drug errors, local anaesthetic systemic toxicity and unusually prolonged neuraxial block regression; and extracorporeal membrane oxygenation use in maternal cardiac arrest.

Is There a Place for Family-centered Cesarean Delivery during Placenta Accreta Spectrum Treatment?

Placenta accreta spectrum (PAS) is a cause of massive obstetric hemorrhage and maternal mortality. The application of family-centered delivery techniques (FCDTs) during surgery to treat this disease is infrequent. We evaluate the implementation of FCDTs during PAS surgeries. This was a prospective, descriptive study that included PAS patients undergoing surgical management over a 12-month period. The patients were divided according to whether FCDTs were applied (group 1) or not (group 2), and the clinical outcomes were measured. In addition, hospital anesthesiologists were surveyed to evaluate their opinions regarding the implementation of FCDTs during the surgical management of PAS. Thirteen patients with PAS were included. The implementation of FCDTs during birth was possible in 53.8% of the patients. The presence of a companion during surgery and skin-to-skin contact did not hinder interdisciplinary management in any case. Implementation of FCDTs during PAS care is possible in selected patients at centers with experience in managing this disease.

How Learning from Trauma Benefits the Obstetric Population? Damage Control Surgery

Abstract The recent implementation of trauma-validated damage control strategies in severe postpartum hemorrhage proves the importance of interdisciplinary management in the obstetric patient. Massive hemorrhage control techniques and damage control surgery are clear examples of how learning from trauma can benefit the obstetric population. Currently, most obstetric programs do not include training in this type of interventions. Nevertheless, it has been shown that these interventions are useful in the management of severe postpartum hemorrhage. The aim of this article is to introduce the application of damage control surgery principles in the management of massive obstetric hemorrhage. We propose to include appropriate training and the implementation of damage control surgery in obstetric management protocols. The prompt application of damage control principles can be considered in patients with persistent hemodynamic instability despite control of the source of bleeding.

Vascular endothelial growth factor (VEGF): A Noninvasive Biomarker for the Prediction of Invasive Placentation

Background: Abnormally invasive placentation (AIP) is a life-threatening obstetric condition which is responsible for massive obstetric hemorrhage that is a leading cause of pregnancy related death. The optimal management of this complication requires a valid antenatal diagnostic tool other than Doppler ultrasound (US). Of these, a handful of laboratory markers have been so far used for the antenatal detection of invasive placentation. Objective: This study sought to establish whether low maternal serum VEGF is related to AIP. Materials and Methods: Over a period of 0ne year, a case control study was conducted in the department of Obstetrics and Gynecology at AL-Yarmouk Teaching Hospital, including 90 pregnant ladies with gestational age 28 week and beyond, of whom 43 cases were diagnosed with placenta accrete using Doppler ultrasound and 47 healthy pregnant ladies with normal placentation. The serum vascular endothelial growth factor was measured by Enzyme-linked immunosorbent assays in all participants, and each individual was followed up regarding intraoperative and postoperative outcomes. Results: a significantly lower serum vascular endothelial growth factor level was found in women having placenta accrete when compared with control group with (P LESS THAN 0.001). At a level of 95.85 pg/ml, serum vascular endothelial growth factor was 90% sensitive, 64% specific in the identification of cases with placenta accrete spectrum. Conclusion: Vascular endothelial growth factor levels may be a potential noninvasive biomarker to aid in the antepartum diagnosis of invasive placentation.

A Strategy of "Resistance Blood Management" in Pregnant Women at Risk of Massive Obstetric Hemorrhage

The purpose of the study: To determine the effectiveness of treatment of anemia with intravenous iron (III) hydroxide sucrose complex (Sufer) in pregnant women with pathological placentation, as the first stage of "patient blood management" before delivery. Our studies have been limited to examining the effectiveness of an iron supplement for the treatment of anemia. Methods: Among 86 pregnant women with placental pathology, 58 (70.7%) had anemia. Severe anemia with a hemoglobin level <70 g/l was in 13 (22.4%), and moderate anemia with a hemoglobin level <90 g/l - in 19 (32.8%). The first group included 18 (31.1%), pregnant women, with placenta previa with periodic blood loss during pregnancy. The second group consisted of 40 (68.9%) pregnant women with the invasive placenta. The gestation period in all women was 33 + 6 weeks. Anemia was treated by administering intravenous iron Sufer 3 times a week (5-7 injections). Results: The main factor that led to pathological placentation was the scar on the uterus. In pregnant women of the second group with invasive placenta, the scar on the uterus was in 38 (95%) women. Severe anemia was present in 2 (11.1%) pregnant women with placenta previa and 2.4 times more often in pregnant women with invasive placenta -11 (27.5%). Moderate anemia was present in 4 (22.2%) women in the first group and in 15(37.5%) in the second group. In pregnant women with severe anemia, after 5-7 injections of the drug Sufer significantly increased the level of hemoglobin by 30 g/l, increased the number of erythrocytes to 2.8x1012/l, increased serum iron by 2 times, the level of ferritin increased to 19.6 μg/l and decreased transferrin content. For pregnant women with moderate anemia, 3-5 injections of the drug were sufficient to normalize the indicators. Normalization of blood parameters allowed to reduce the risk of bleeding, and the number of blood transfusions and improved treatment outcomes. Conclusion: Timely diagnosis of iron deficiency anemia in pregnant women with placental pathology is an important means of preventing massive blood loss and reducing the number of blood transfusions, as the first stage of the strategy "patient blood management". Intravenous iron (III) sucrose complex hydroxide (Sufer) has shown high clinical efficacy in the treatment of iron deficiency anemia in pregnant women with placental pathology and can be recommended for widespread use in practical medicine.

Mean Blood Loss in Third Stage of Labour Treated with and without Prophylactic Tranexamic Acid

Background: Massive obstetrical hemorrhage, a leading contributor towards maternal fatality in economically developing countries, is occasionally related with the passive and apathetic management of the third stage of labor. The increasing frequency of anaemia among pregnant women in developing countries, mild to moderate blood loss during labour necessitates massive transfusions with associated complications. Aim: Recent studies claimed that prophylactic tranexamic acid can significantly reduce the mean blood loss during 3rd stage of labour and advocated it in future practice. Methods: The research was conducted as randomized controlled trial carried out from February 2021 to October 2021 in the Department of Diagnostic Radiology and Obstetrics & Gynaecology Department, Ganga Ram Hospital, Lahore. A total of 116 pregnant women aged between 18-35 years presenting in labor at term (37-42 weeks of gestation as per dating scan) which were randomly allocated into two groups. Patients in Group-A were given additional tranexamic acid at the end of 2nd stage of labor while those in Group-B received conventional treatment alone. Results: Patients were 28.33±4.77 years with the mean age while the mean gestational age at delivery was 39.39±1.69 weeks. 30(25.9%) women were primiparas and 86 (74.1%) were multiaparas. The mean BMI of these patients was 27.50±3.90 Kg/m2 while the average duration of 3rd stage of labor was 4.69±1.83 minutes. Patients taking prophylactic tranexamic acid lost significantly less blood in the third stage of labors than controls (244.83±21.47 vs. 354.09±22.36 ml; p-value<0.001). Conclusion: In the present study, prophylactic tranexamic acid was found to significantly reduce the mean blood loss during 3rd stage of labor which along with low cost, widespread availability and oral administration advocates the routine use of tranexamic acid (during 3rd stage of labor) in future obstetric practice to minimize blood loss with subsequent decreased need for blood transfusion and better patient’s recovery. Keywords: Third Stage of Labor, Blood Loss, Tranexamic Acid

Prevention and therapy of massive obstetric bleeding with placenta percreta 3b

The objective: to reduce the intra- and postoperative complications, massive intraoperative blood loss during abdominal delivery of pregnant women with placenta percreta 3b using endovascular technique of temporary balloon occlusion of the infrarenal abdominal aorta. Materials and methods. Caesarean section in the uterus fundus was performed in 21 pregnant women with placenta percreta and invasion of perivesical tissue, partial invasion to the posterior wall of the bladder (degree of invasion 3b). The main group included 7 pregnant women who had lower median laparotomy and caesarean section in the uterine fundus with balloon occlusion of the infrarenal abdominal aorta after fetal removal and subsequent hysterectomy without uterine appendages and bladder fundus plastics. The comparison group included 14 pregnant women with caesarean section in the uterus fundus without prior balloon occlusion of the abdominal aorta with subsequent hysterectomy without uterine appendages and suturing of the bladder fundus defect in the area of ​​its invasion of placental tissue. Pregnant women of both groups were representative for age, parity, somatic pathology. The diagnosis in all cases was confirmed by ultrasound examination with Doppler and magnetic resonance imaging. All pregnant women were delivered in 36-37 weeks of gestation. The article also presents a clinical case: delivery of a pregnant woman with placenta percreta and invasion in the posterior wall of the bladder using an innovative technique to minimize blood loss, which was conducted at the Kyiv Regional Perinatal Center. Results. It was determined that delivery by caesarean section with balloon occlusion of the abdominal aorta and subsequent hysterectomy without uterine appendages and bladder fundus plastics reduces blood loss (from 1758.0±110.0 ml to 955.0±70.0 ml), duration of surgery (from 112.0±11.0 min to 87.0±9.0 min), duration of hospitalization (from 11±2 days to 7±1 days), the need for blood transfusions and improves long-term consequences. Conclusions. Innovative technology for temporary balloon occlusion of infrarenal abdominal aorta after cesarean section in the uterus fundus and subsequent hysterectomy without uterine appendages in women with placenta percreta 3b significantly reduces blood loss, the likelihood of massive bleeding, organ damage, duration of hospitalization.

Features of pregnancy, childbirth and postpartum in women with uterine leiomyoma

The objective: to determine the effect of uterine fibroid on the features of pregnancy, childbirth and possible complications during pregnancy delivery and postpartum. Materials and methods. We analyzed 10684 histories of pregnancy and childbirth for 3 years (2019–2021). The main group of pregnant women included 363 cases with fibroid (3.39% of the total). The comparison group consisted of pregnant women without fibroid (10,321 births (96.61% of total)). Results. We found that the following factors as the age of the pregnant woman, high BMI, smoking and alcohol consumption were of significant risk (p<0.05) regarding the fibroid progression and its effect on the course of pregnancy, which affected the development of gestational diabetes and hypertensive disorders in pregnant women with fibroid. The rate of delivery by caesarean section in women with fibroid reached 59.0% compared with 23.4% in the group without fibroid (p<0.001). An association between fibroid and an increased risk of caesarean section was confirmed (OR 4.7; 95% CI: 3.8–5.8). The size of the fibroid node significantly increased the likelihood of placentation pathology as placenta previa in the subgroup with the size of the node >5 cm, the likelihood of preterm birth, as well as the volume of postpartum hemorrhage (p<0.05). The fibroid node type proved a statistically significant effect on the incidence of placental abruption, especially in the case of placental attachment close to the submucosal node compared with another type of nodes (intramural or subserous) – 6.9% vs. 0.8% respectively in the case of intramural fibroid and 0% for subserous fibroid p<0.01. Conclusions. According to the results of a retrospective study, we proved that pregnant women with uterine fibroid are at greater risk of complications of pregnancy, childbirth and the postpartum period. There is a direct relationship between pregnancy in the background of fibroid and the likelihood of placenta previa, increased frequency of caesarean section and the development of postpartum hemorrhage.The relationship between different characteristics of the uterine fibroid (its type, size, localization, number of nodes) and the likelihood of massive obstetric bleeding has been proven. We focus on the aspect of prognosis, determination by obstetrician-gynecologists of a high-risk group for developing postpartum hemorrhage in pregnant women with uterine leukemia for the purpose of timely prevention and treatment of massive obstetric hemorrhage and the development of coagulopathic disorders.

567 Compression of the lower uterine segment (colus) – new technique for reducing the bleeding during c-section in women with placenta previa

Objectiveto evaluate efficiency of a new approach for bleeding prevention and cessation during C-section in pregnant women with placenta previa. Study design: 61 pregnant women with diagnosed by ultrasound examination placenta previa were recommended planned operative delivery. All of them were randomized and divided into 2 groups. Study group (n=30) had elective C-section at 36-36+6 gestation weeks using our modified method of surgical hemostasis (COLUS): after placenta's we perfomed compressive suture on the lower uterine segment, uterine vessels' ligation and placed catheter inside the uterine cavity. All patients received prevention of neonatal RDS. Pregnant women in control group (n=31) had planned caesarean section at 38-39 weeks. Hemostasis of the area of the placenta location was reached by using electrocoagulation of the lower uterine segment vessels and additional suturing of bleeding areas, wherever necessary. Intraoperative blood loss and neonatal outcomes in both groups were evaluated, analyzed and compared respectively. Newborns’ condition was assessed using Apgar score at the 1st and 5th minute after delivery. Results: Bleeding control was achieved in all patients (100%). Average intraoperative blood loss in control group was 1277 ± 119 mL vs. 698±139 mL - in study group. Apgar score at 1'-5' min ranged between 7 and 9 in both groups. Weight and length of newborns were 2679±33g and 47±1cm for study group vs. 3151±78g and 48±1cm for control group, that matches the normal values for that gestational ages. No major complications occurred in both groups. Conclusions: tactic developed by us allows to prevent massive obstetric hemorrhage in most cases of placenta previa during cesarean section and lead to reduction of intraoperative blood loss by 45%.

Efficacy of Resuscitative Infusion With Hemoglobin Vesicles in Rabbits With Massive Obstetric Hemorrhage

(Am J Obstet Gynecol. 2021;224:398.e1–398.e11. doi: 10.1016/j.ajog.2020.09.010. Epub September 12, 2020) Massive transfusion protocol (MTP) is a management strategy for massive obstetric hemorrhage (MOH), an unpredictable birth complication, yet small maternity clinics and birth centers don’t always have access to MTP. Red blood cell (RBC) transfusion is optimally administered to patients requiring resuscitative infusion following MOH, but there are logistical limitations to providing small maternity clinics and birth centers with the supplies required for treatment. Thus, hemoglobin vesicles (HbVs) have been developed and tested as an RBC transfusion substitute with a much more practical and stable shelf life, making it much more affordable for small hospitals to have on hand. Though HbVs are logistically beneficial, there are questions around its efficacy and safety, so animal models have been developed to address these. This study used a rabbit model to substitute RBC transfusion with MOH to show efficacy of HbVs in rabbits with MOH.

A case series on abnormal placenta accreta spectrum in a rural tertiary care centre

Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The main complication of PAS is due to it’s massive obstetric haemorrhage which leads to maternal morbidity and mortality. The incidence of placenta accreta spectrum increases day by day due to an alarming increase in caesarean section rates. Depending on the range of invasiveness, The Placenta accreta spectrum is classified as placenta accreta, placenta increta and placenta percreta. The etiology of placenta accreta spectrum is that a defect of the endometrial–myometrial interface leading to failure of normal decidualization in the area of a uterine scar, which allows abnormally deep placental anchoring villi and trophoblast infiltration. In recent times, prenatal ultrasound scanning with gray scale imaging and color Doppler imaging seems to be an excellent tool for screening of PAS.We report here a series of 5 cases of Placenta Accreta who reported to hospital as Bleeding P/v or USG scan report showing Abnormal Placental invasion or Placental Position. Patients reported were posted for Emergency LSCS under definitive indications but underwent Peripartum hysterectomy. The Ultrasound findings were subsequently confirmed at surgery and proven on histopathological examination. Peripartum hysterectomy remains the life saving procedure over conservative methods for PPH secondary to Abnormal Placental invasion.

КЛИНИЧЕСКИЙ СЛУЧАЙ ВЕДЕНИЯ ПАЦИЕНТКИ С МАССИВНЫМ АКУШЕРСКИМ КРОВОТЕЧЕНИЕМ

A clinical case of massive obstetric bleeding complicated by hemorrhagic shock, extirpation of the uterus without appendages, ligation of the internal iliac arteries on both sides is presented. The difficulties of diagnosis and treatment are analyzed. This clinical case allows to disseminate the experience of managing patients with massive obstetric bleeding.

СНИЖЕНИЕ ФУНКЦИИ ЯИЧНИКОВ ПОСЛЕ ЭМБОЛИЗАЦИИ МАТОЧНЫХ АРТЕРИЙ ВО ВРЕМЯ МАССИВНОГО АКУШЕРСКОГО КРОВОТЕЧЕНИЯ

Postpartum haemorrhage is still the leading cause of maternal morbidity and mortality. Uterine artery embolisation (EMA) is an effective organ-preserving treatment for uncontrolled obstetric haemorrhage. To date, there is evidence that EMA may lead to a reduction in ovarian reserve. In the present study, we retrospectively and prospectively analyzed clinical manifestations of ovarian dysfunction in 30 women of reproductive age 1.5 years after uterine artery embolization during massive obstetric bleeding.

Doctors' criminal liability in case patient's death due to massive obstetric bleeding

Doctors' criminal liability in case patient's death due to massive obstetric bleeding

Features of pregnancy, delivery and postpartum on the background of assisted reproductive technologies

The objective: to establish the characteristics of the course of pregnancy and childbirth after the use of assisted reproductive technologies (ART); to stratify the risks in this contingent of pregnant women, to determine the high-risk subgroup among pregnant women after the use of ART and the formation of possible preventive approaches for these categories of patients. Materials and methods. A retrospective analysis of 3450 histories of pregnancy and childbirth that occurred during 2018–2020, was carried out. Inclusion criteria: first singleton delivery in cephalic presentation without critical congenital malformations in the fetus and severe somatic pathologies in pregnant women aged 18–45 years. Two groups were formed: a group with spontaneous pregnancy (3137 histories) and a group with pregnancy after ART (313 histories), which, according to the age factor, were divided into subgroups of active (2686 and 159 histories, respectively) and late reproductive age (451 and 154 histories, respectively).For statistical analysis, odds ratio (OR) and 95% confidence interval (CI) were calculated. The χ-square test was used to assess the significance of the difference in proportions. The level of statistical significance was at p<0.05.Results. The frequency of normal births in the subgroup of late reproductive age with pregnancy after the use of ART was 38.8%, that almost 2 times lower than in the subgroup of spontaneous pregnancy in women of late reproductive age (65.5%; p<0.05). Patients with late reproductive age and pregnancy after using ART (28.5%) had two times higher chances of induction of labor compared with the spontaneous pregnancy subgroup (14.3%; p<0.05). The incidence of cesarean section was 51.1% in the ART subgroup compared to 27% in the spontaneous pregnancy subgroup (p<0.05). In the subgroup of late reproductive age and pregnancy after ART, the probability of cesarean section was in 1.7 times higher than in the subgroup of active reproductive age and pregnancy after ART. The risks of developing massive obstetric bleeding in patients with late reproductive age and pregnancy after ART were in 5.5 times higher than in patients with spontaneous pregnancy (p<0.05) and 2.8 times higher than in patients of active reproductive age and pregnancy after ART. The rate of normal induced labor in the ART group in women under 35 years of age was 51.7%, while in the subgroup of late reproductive age patients with pregnancy after ART, this indicator decreased to 23.5%. The incidence of unsuccessful induction of labor in patients with late reproductive age and pregnancy after ART was 19.6%, the frequency of cesarean section after induced labor in the subgroup of late reproductive age and pregnancy after ART was 70.6%. The likelihood of the massive obstetric bleeding development during induced labor in patients with late reproductive age and pregnancy after ART was in 5 times higher than in spontaneous pregnancy in this age subgroup (OR 5.05; 95% CI: 0.94-27.05) and 6.8 times higher than in the subgroup of active reproductive age after the use of ART (OR 6.84; 95% CI: 2.2-21.24). The newborns conceived after ART and after induced labor had in 2.8 times greater risks of the necessity for primary neonatal resuscitation.Conclusions. The pregnancy and labor after ART were characterized by a higher incidence of preterm birth, caesarean section, assisted vaginal delivery, and massive obstetric bleeding. The rate of complications significantly increased in women of late reproductive age. For patients with pregnancy after the use of ART, it is advisable to conduct labor using continuous cardiotocography monitoring, timely correction of labor abnormalities according to the partogram, the use of modern effective algorithms for the prevention of obstetric bleeding. For the pregnant women of late reproductive age after ART in the absence of spontaneous onset of regular labor, we recommend to consider the possibility of a planned caesarean section at 40–41 weeks of gestation.

Total Placenta Previa with High-risk MAP and Transverse Lie Fetal Position

Placenta accreta is one of the emergency conditions and has resulted in increased mortality and morbidity of pregnant women due to the massive obstetric hemorrhage. Placenta accreta can lead to secondary complications including coagulopathy, multisystem organ failure, acute respiratory distress syndrome, need for repeat surgery, and death. Assessment by anesthesia should be carried out as early as possible before surgery to reduce or even eliminate morbidity and mortality. In this report, we present the case of a patient with total placenta previa and high-risk MAP score with a transverse lie fetal position. The various anesthetic treatments and transfusion strategies are discussed with a multidisciplinary approach to delivery.

Efficacy of distal haemostasis during caesarean delivery in women with placenta accreta spectrum disorders

Pregnancies complicated by the placenta praevia are associated with an increased risk of massive obstetric bleeding and high rates of hysterectomy which are often caused by the placenta accreta. The aim of our study was to identify the risk factors for placenta praevia associated with PAS disorders and the efficacy of distal haemostasis during Cesarean delivery. Methods This was a cohort study carried out between 2014 and 2020 in 532 women with abnormal placental localization and attachment. The placental attachment spectrum (PAS) disorder diagnosis was confirmed during the surgery and by the histology results in 164/532 participants. Depending on the surgical approach during the Cesarean delivery, patients were divided into three groups. In Group 1 (n = 52), patients underwent bilateral uterine artery ligation. In Group 2 (n = 33), we used the combined compression haemostasis approach including the placement of tourniquets and insertion of an intrauterine balloon for controlled tamponade. In Group 3 (n = 79), we used the combination of surgical haemostasis with the controlled intrauterine tamponade using the vaginal and intrauterine Zhukovsky balloon. Results PAS was observed in 30.8% of the placenta praevia cases, and in 93.3% was associated with the presence of a uterine scar. Women with the placenta praevia and PAS had a significantly higher number of past deliveries (р = .001). According to the FIGO classification, 53.8% of women with placenta praevia observed during the Cesarean had РА1 and 46.2% PA2. With regards to the PAS disorders observed in 30.8% of patients, 38.4% had PAS3, 34.7% PAS4, 18.3% PAS5 and 8.5% PAS6. The histology analysis showed normal placental attachment in 42.9% of the total number of study participants, placenta accreta in 28.2%, placenta increta in 16.7%, and placenta percreta in 12.2%. In Group 1, we performed the resection of uterine wall with the attached portion of the placenta in 13.5% of women, in Group 2 in 30.3% women, and in Group 3 in 50.6% women. There was a significant 4.8-fold reduction in the number of hysterectomies in Group 3 versus Group 2 (р = .043) and a 4.4-fold reduction in Group 2 versus Group 1 (р = .003). In Group 2, the volume of blood loss was 1.3-fold lower and in Group 3 1.5-fold lower than in Group 1. Conclusion: The techniques of compression distal haemostasis evaluated in this study in women with PAS are efficacious in the reduction of adverse maternal outcomes and should be used more widely in clinical practice.

Особенности лечения массивного акушерского кровотечения в ретроспективной группе

В статье приводятся анализ причин массивных акушерских кровотечений, особенности лечения, возможные допущенные ошибки консервативного и оперативного лечения в ретроспективной группе исследуемых пациентов на базе областного перинатального центра в г. Ургенче Хорезмской области в Республике Узбекистан.

Thromboelastometry（ROTEM®）により早期に凝固異常を察知し， 輸血治療を行った産科大量出血の１例

Thromboelastometry（ROTEM®）により早期に凝固異常を察知し， 輸血治療を行った産科大量出血の１例