Comparative evaluation of the efficiency of surgical hemostatic techniques during organ-sparing delivery in patients with placenta increta
Objective. To assess the results of using various surgical hemostatic techniques (internal iliac artery (IIA) ligation, temporary common iliac artery (CIA) occlusion, and complex hemostasis compression) during cesarean section in patients with placenta increta.Vinitsky A.A., Shmakov R.G., Chuprynin V.D.
Subject and methods. For comparative evaluation of the efficiency of the proposed techniques, 3 groups of patients with placenta increta, who had undergone one of the surgical hemostatic techniques during caesarean section, were identified. IIA ligation was used in Group 1 (n=15) and temporary CIA was done in Group 2 (n=18). Group 3 (n=21) underwent complex hemostasis compression including the application of bilateral tourniquets to the base of the broad ligaments and cervico-isthmus region of the uterus, which had been complemented by controlled uterine balloon tamponade.
Results. Complex hemostasis compression is the most effective technique, in which the average blood loss was 1295±520.3 ml (p=0.0045), a blood loss of over 2000 ml occurred in 2 (9.5%) cases (p=0.0411). In Groups 1 and 2, blood losses were 2440±1215 and 2186±1353 ml, respectively. Massive blood loss over 2000 ml was observed in more than 50% when blood circulation was stopped along both the bed of CIA and IIA. Length of surgery, changes in hemoglobin levels, frequency of hysterectomies, and duration of hospital stay after delivery were not significantly different.
Conclusion. Complex hemostasis compression is the most effective technique to reduce blood loss and the most effective organ-sparing method during operative delivery in patients with placenta increta.
Keywords
placenta increta
cesarean section
obstetric hemorrhage
internal iliac artery
common iliac artery
complex hemostasis compression
Supplementary Materials
- Table 1. Clinical and anamnestic characteristics of the study groups
- Table 2. Intraoperative and postoperative characteristics
- Table 3. Frequency of maternal complications
- Fig. 1. Complex compression hemostasis. A. Schematic representation of the overlay I turnstile bundles bilaterally on the basis of the broad ligament, which thereby captured the fallopian tubes, mezosalpinks, own ovarian ligament and the neck-region of the uterus peresheechnuyu projected division of the uterine artery to the ascending and descending branch. Step B. l overlay harness turnstile ateralnogo
- Fig. 2. The total amount of blood loss, depending on the method of surgical haemo stasis during cesarean section
References
1. Cali G., Forlani F., Giambanco L., Amico M.L., Vallone M., Puccio G., Alio L. Prophylactic use of intravascular balloon catheters in women with placenta accreta, increta and percreta. Eur. J. Obstet. Gynecol. Reprod. Biol. 2014; 179: 36-41.
2. Fitzpatrick K.E., Sellers S., Spark P., Kurinczuk J.J., Brocklehurst P., Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population based descriptive study. BJOG. 2014; 121(1): 62-70.
3. Morlando M., Sarno L., Napolitano R., Capone A., Tessitore G., Maruotti G.M., Martinelli P. Placenta accreta: incidence and risk factors in an area with a particularly high rate of cesarean section. Acta Obstet. Gynecol. Scand. 2013; 92(4): 457-60.
4. Jauniaux E., Collins S., Burton G.J. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am. J. Obstet. Gynecol. 2017; Jun 24. pii: S0002-9378(17)30731-7.
5. Cho YJ, Oh YT, Kim SY, Kim JY, Jung SY, Chon SJ, Kim JH, Byun SS. The efficacy of pre-delivery prophylactic trans-catheter arterial balloon occlusion of bilateral internal iliac artery in patients with suspected placental adhesion. Obstet Gynecol Sci. 2017 Jan;60(1):18-25. doi: 10.5468/ogs.2017.60.1.18. Epub 2017 Jan 19.
6. Sinan Al-Hadethi, Shane Fernando, Simon Hughes, Ajay Thakorlal, Adam Seruga and Bonnie Scurry. Does temproray bilateral balloon occlusion of the common iliac arteries reduce the need for intra-operative blood transfusion in cases of placenta accretism? J Med Imaging Radiat Oncol. 2017 Jun;61(3):311-316. doi: 10.1111/1754-9485.12560. Epub 2016 Dec 16.
7. AbdRabbo SA (1994) Stepwise uterine devascularization: A novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol 171:694–700.
8. Palacios-Jaraquemada J.M. Caesarean section in cases of placenta praevia and accrete. Best Pract. Res. Clin. Obstet. Gynaecol. 2013; 27(2):221-32.
9. Barinov S.V., Zhukovskiy Ya.G., Medyannikova I.V., Shavkun I.V., Zhilin A.V., Razdobedina I.N., Grebenyuk O.A., Kovaleva Yu.A. Experience with vaginal and uterine catheters Zhukovskiy and a topical hemostatic agent in the treatment of postpartum bleeding during cesarean section. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2016; (7): 34-40. (in Russian) http://dx.doi.org/10.18565/aig.2016.7.34-40
Received 16.06.2017
Accepted 23.06.2017
About the Authors
Vinitskiy A.A., postgraduate student of maternity departments, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79253620232. E-mail: drvinitskiy@gmail.com
Shmakov R.G., MD, PhD, The Chief medical officer, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954387300. E-mail: r_shmakov@oparina4.ru
Chuprynin V.D., MD, PhD, The Head of the surgeon department, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954383575. E-mail: v_chuprynin@oparina4.ru
For citations: Vinitsky A.A., Shmakov R.G., Chuprynin V.D. Comparative evaluation of the efficiency of surgical hemostatic techniques during organ-sparing delivery in patients with placenta increta. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (7): 68-74. (in Russian)
http://dx.doi.org/10.18565/aig.2017.7.68-74
Similar Articles
