1/12. Transient myocardial ischemia may occur following subendometrial vasopressin infiltration.A case of transient myocardial ischemia following subendometrial vasopressin infiltration in intractable intra-operative postpartum bleeding due to placenta accreta is described. In our experience, the rate of this side effect is one in 14 patients (rate of 7.1%). We believe that the benefits of the treatment outweigh the risks, since the uterus was saved in all 14 patients. Nevertheless, this case emphasises that extreme precaution is needed with subendometrial vasopressin infiltration. It should be emphasised that the needle must not be within a blood vessel because intravascular injection of vasopressin solution can precipitate acute arterial hypertension, bradycardia and even death. We suggest that local vasopressin infiltration into the placental site is indicated in cases of intractable bleeding at cesarean section after other conventional obstetric and pharmacological maneuvers have failed.- - - - - - - - - - ranking = 1keywords = placenta (Clic here for more details about this article) |
2/12. Prophylactic perioperative hypogastric artery balloon occlusion in abnormal placentation.OBJECTIVE: The aim of this paper is to describe and evaluate the technique of prophylactic balloon occlusion of hypogastric arteries in abnormal placentation. Five patients with suspected placenta accreta, placenta percreta, or placenta increta underwent perioperative balloon occlusion of hypogastric arteries after classic cesarean delivery and before hysterectomy with hypogastric artery ligation. Two patients did not require transfusions; of the three who did, the estimated blood loss ranged from 1100 to 4000 mL. CONCLUSION: We conclude that balloon occlusion of the hypogastric arteries is a safe and effective adjunct to cesarean hysterectomy in an attempt to minimize blood loss in patients with abnormal placentation.- - - - - - - - - - ranking = 4.5keywords = placenta (Clic here for more details about this article) |
3/12. Normovolemic hemodilution before cesarean hysterectomy for placenta percreta.BACKGROUND: Placenta percreta can create life-threatening hemorrhage at the time of delivery. The additional challenge of patient refusal of blood transfusion for religious reasons requires the use of comprehensive blood-conserving strategies. CASE: A Jehovah's Witness with two previous cesarean deliveries and a placenta previa was diagnosed antenatally as having placenta percreta. Acute normovolemic hemodilution was performed in conjunction with cesarean hysterectomy with no maternal or fetal side effects. CONCLUSION: Acute normovolemic hemodilution can be used safely in the pregnant woman at high risk for excessive intraoperative blood loss and should be considered in obstetric patients who strictly adhere to religious convictions prohibiting the acceptance of blood products.- - - - - - - - - - ranking = 8.3023447761077keywords = placenta previa, placenta, previa (Clic here for more details about this article) |
4/12. Embolization for advanced abdominal pregnancy with a retained placenta. A case report.BACKGROUND: Abdominal pregnancy is not encountered commonly, and management of the placenta is controversial. CASE: A 33-year-old woman presented with an abdominal pregnancy at 33 weeks' gestation with fetal death. The placental vasculature was embolized preoperatively. Following operative delivery. of the fetus, the placenta was left in situ in efforts to preserve fertility given its implantation on the reproductive organs. The patient suffered prolonged postoperative ileus but otherwise did well. Placental function ceased after two months. CONCLUSION: Placental vasculature embolization is a management option for a retained placenta associated with abdominal pregnancy.- - - - - - - - - - ranking = 4keywords = placenta (Clic here for more details about this article) |
5/12. Intraoperative blood salvage during cesarean delivery in a patient with beta thalassemia intermedia.In this case report, we report a patient with a placenta accreta and thalassemia intermedia undergoing cesarean delivery. There are no data regarding the use of cell salvage in patients with thalassemia. During the course of her surgery, she lost approximately 9000 mL of blood. Of this blood, 2250 mL of concentrated red cells were collected, washed, and returned to the patient. During processing, increased hemolysis was noted in the effluent line of the cell salvage machine, which resolved by increasing the wash volume. The patient's postoperative course was uneventful. This case would suggest that cell salvage in patients with thalassemia can be performed safely; however, further study is warranted. IMPLICATIONS: This case report details the safe administration of cell salvage in a patient with beta thalassemia undergoing cesarean delivery. Cell salvage is the collection, washing, and re-administration of blood lost during surgery. This process has not been previously reported in a patient with this type of blood disease.- - - - - - - - - - ranking = 0.5keywords = placenta (Clic here for more details about this article) |
6/12. Novel hemostatic alternatives in reconstructive surgery.Congenital vascular lesions are classed as hemangiomas, vascular malformations, or vascular tumors according to their histology and etiology. The majority of hemangiomas are benign and often involute before the child reaches the age of 12. Severe hemangiomas and vascular malformations were historically viewed as effectively inoperable due to the high risk of potentially catastrophic bleeding during surgery. An effective system of classification and increasing range of therapeutic options have improved the prognosis for many patients, but surgical resection of these lesions remains a serious undertaking. Topical hemostatic agents are widely used and effective in many cases for the control of intraoperative bleeding. The main limitations of these agents are their variability and lack of efficacy in severe bleeding, or in coagulopathic or anticoagulant-treated patients. This paper reviews recent developments in this field, including the possible placental origin of hemangiomas, and discusses current approaches to hemostasis during reconstructive surgery. We also discuss the recent introduction of recombinant activated factor vii (rFVIIa) as a systemic hemostatic agent, including our own experience using this treatment.- - - - - - - - - - ranking = 0.5keywords = placenta (Clic here for more details about this article) |
7/12. Autologous cord blood transfusion in an infant with a huge sacrococcygeal teratoma.We describe a case of cord blood harvest for autologous transfusion in a neonate weighing 3,992 g with a giant sacrococcygeal teratoma. The umbilical vein was pierced with an 18-gauge needle, and placental blood was withdrawn into two 50-ml syringes filled with 4 ml of citrate-phosphate-dextrose solution. Resection of the sacrococcygeal teratoma was performed on day one. During the operation the infant lost 46 ml of whole blood, more than 15% of the estimated total blood volume, and thus underwent autologous transfusion with 27.8 ml of packed red cells obtained from autologous cord blood. Consequently, she could avoid homologous blood transfusion during the hospital stay. This case highlights the safety of this procedure, with no evidence of consumption coagulopathy, hemolysis or bacterial infection.- - - - - - - - - - ranking = 0.5keywords = placenta (Clic here for more details about this article) |
8/12. Cesarean scar dehiscence as a cause of hemorrhage after second-trimester abortion by dilation and evacuation.women who have had a cesarean section have a risk of uterine rupture when undergoing a second-trimester pregnancy termination. Beyond the first trimester, uterine rupture has been associated with the use of labor-induction agents and, less often, a placenta accreta. Scar dehiscence, a less disruptive form of scar separation, has not been reported with dilation and evacuation abortion. We present two cases of uterine scar dehiscence causing serious bleeding after otherwise uncomplicated dilatation and evacuation procedures. Neither case was associated with uterine contractions, an iatrogenic perforation or placenta accreta. Uterine scar dehiscence, a surreptitious process, can be the cause of hemorrhage after uncomplicated dilatation and evacuation.- - - - - - - - - - ranking = 1keywords = placenta (Clic here for more details about this article) |
9/12. Tourniquet technique prevents profuse blood loss in placenta accreta cesarean section.AIM: Profuse bleeding in placenta accreta is life-threatening even under well-prepared cesarean sections. methods: We used a tourniquet technique to temporally shut off blood flow through the uterine and ovarian vessels at the level of the uterine cervix. The tourniquet consisted of manual compression followed by a rubber tube. RESULTS: Total blood loss in cesarean section and hysterectomy in the two cases in which we applied this technique was significantly reduced compared with that in the two cases without it. CONCLUSION: This technique not only prevented massive bleeding from the accreted placentation, but also allowed physicians time to consider the necessity of subsequent hysterectomy.- - - - - - - - - - ranking = 3keywords = placenta (Clic here for more details about this article) |
10/12. Angiographic arterial embolization and computed tomography-directed drainage for the management of hemorrhage and infection with abdominal pregnancy.Hemorrhage during or after surgery, pelvic abscess, bowel obstruction, and prolonged febrile morbidity can complicate the puerperal course of the gravida after removal of an extrauterine fetus with nondisturbance of the extrauterine placenta. In this report we describe the successful angiographic arterial gelfoam embolization of the placental vascular bed to control heavy postoperative hemorrhage in a mother suffering adult respiratory distress syndrome after removal of the fetal portion of her abdominal pregnancy. Six weeks later, computed tomography (CT)-directed drainage by catheter of a placental abscess was performed. Selective angiographic transcatheter embolization with gelfoam is a useful tool for the control of hemorrhage in the gravida who is an unfavorable operative candidate or who may present technical hemostasis problems peculiar to the placenta with abdominal pregnancy. Later use of CT-directed catheter drainage of the infected residual placental mass provided a nonoperative means of treatment.- - - - - - - - - - ranking = 2.5keywords = placenta (Clic here for more details about this article) |
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