1/10. A useful technique for the control of severe cesarean hemorrhage: report of three cases.When we are confronted with a patient experiencing placenta previa with massive hemorrhage in cesarean delivery, hemostasis is first attempted using uterotonic drugs, uterine massage, and intrauterine packing. However, if these maneuvers fail, then uterine artery ligation, whole myometrial suture, and subendometrial vasopressin injection should be attempted. Perhaps these procedures alone or in combination can successfully control the hemorrhage. Every obstetrician must be familiar with these simple methods in order to avoid having to perform a hysterectomy and thus preserving the reproductive capability, as well as diminishing the operative morbidity. Finally, we described a full thickness suture for the placental site of bleeding for the lower uterine segment.- - - - - - - - - - ranking = 1keywords = previa (Clic here for more details about this article) |
2/10. Sengstaken-Blakemore tube to control massive postpartum haemorrhage.Massive postpartum haemorrhage after cesarean section for placenta previa is a common occurrence. The bleeding is usually from the placental bed at the lower uterine segment. Uterine tamponade has a role in the management of such patients especially when fertility is desired. We describe here a case of massive postpartum haemorrhage, which was managed, with the use of a Sengstaken-Blakemore tube. This allowed us to avoid a hysterectomy for a young primiparous patient.- - - - - - - - - - ranking = 1keywords = previa (Clic here for more details about this article) |
3/10. placenta previa and accreta complicated by amniotic fluid embolism.BACKGROUND: The simultaneous occurrence of placenta previa and placenta accreta in patients who had previous low transverse cesarean delivery is presently well established. However, the sequence of previous cesarean delivery followed by placenta previa and accreta in a patient who also experiences a premature rupture of membranes as well as amniotic fluid embolism (AFE) is a rare obstetric phenomenon. CASE: A 24-year-old woman, para 2 with two previous cesarean deliveries, at 32 weeks' gestation by last menstrual period, was admitted with premature rupture of membranes. A repeat cesarean delivery (CD) was done. Excessive hemorrhage occurred, necessitating a hysterectomy. Also, the patient developed an amniotic fluid embolism. CONCLUSION: placenta previa and placenta accreta may be observed in patients who have a previous CD scar and in whom AFE develops suddenly and unexpectedly. AFE, a condition with complex pathogenesis, presents a number of challenges, with the patient undergoing serious complications that may include massive hemorrhage, disseminated intravascular coagulopathy, and death. The obstetrician should be alert to the symptoms of AFE, and if they occur should begin prompt and aggressive treatment.- - - - - - - - - - ranking = 7keywords = previa (Clic here for more details about this article) |
4/10. Massive obstetric hemorrhage due to placenta previa/accreta with prior cesarean section.There is a high association between anterior placenta previa, placenta accreta and previous cesarean section. We report three cases which illustrate the particular danger of massive hemorrhage posed by placenta previa/accreta in a scarred uterus. As the incidence of cesarean section continues to rise worldwide, the problem of placenta previa/accreta is likely to become more common. We emphasize the need for each obstetric unit to have a protocol for dealing with massive hemorrhage.- - - - - - - - - - ranking = 7keywords = previa (Clic here for more details about this article) |
5/10. Arterial embolus during common iliac balloon catheterization at cesarean hysterectomy.BACKGROUND: placenta accreta is associated with significant maternal morbidity. Prophylactic iliac artery balloon placement has been described as a treatment adjunct to minimize maternal risk of excessive blood loss at hysterectomy. CASE: A 37-year-old multigravida presented at 37 weeks of gestation with a known placenta previa and suspected placenta accreta. iliac artery balloon catheters were placed immediately before cesarean delivery. The balloons were inflated after the infant was delivered, and placental-site hemorrhage required a cesarean hysterectomy with a 1,500-mL blood loss. A left popliteal arterial thrombus diagnosed postoperatively required thromboembolectomy. The patient was discharged home on postoperative day 5 with no further sequelae. CONCLUSION: Prophylactic arterial balloon occlusion may be associated with risks unique to pregnant women.- - - - - - - - - - ranking = 1keywords = previa (Clic here for more details about this article) |
6/10. placenta accreta, increta, and percreta. A survey of 40 cases.Forty patients with placenta accreta, increta, or percreta are presented. Clinical features revealed an average age of 29.5 years and an average parity of 3-2-1. Twenty-five had no antepartum complications. Nine were admitted with silent hemorrhage, of which 6 had a total placenta previa and 1 a low-lying previa. postpartum hemorrhage occurred in 39% with an associated perinatal mortality of 25% and 1 maternal death. Histopathologic evaluations revealed the predominant factor to be an absent decidua. Etiologic in decidual deficiency was a previous cesarean section (12 patients). Therapy consisted of total abdominal hysterectomy in 38 patients.- - - - - - - - - - ranking = 2keywords = previa (Clic here for more details about this article) |
7/10. placenta previa percreta with fetal survival.A case of placenta previa percreta accompanied by massive hemorrhage is described. Both the mother and fetus survived. Anticipation of this rare obstetric condition is both possible and essential for optimum management.- - - - - - - - - - ranking = 5keywords = previa (Clic here for more details about this article) |
8/10. A thrombogenic uterine pack for postpartum hemorrhage.BACKGROUND: A low-lying placenta or placenta previa is frequently associated with postpartum hemorrhage from a low implantation site. We describe the successful use of a thrombin-soaked uterine pack for this condition. CASE: A 30-year-old woman, gravida 3, para 0-0-2-0, had placenta previa diagnosed by ultrasound at 26 weeks' gestation. A repeat examination at 35 weeks demonstrated a low-lying placenta. The patient had an uncomplicated intrapartum course and was delivered by vacuum extraction, but excessive vaginal bleeding was noted 3 hours after spontaneous delivery of the placenta. oxytocin, prostaglandin, and uterine curettage failed to control the hemorrhage. In an attempt to avoid laparotomy, we placed a thrombin-soaked uterine pack over the bleeding site. There was minimal vaginal bleeding during the following 8 hours, so the pack was removed. The patient had no further complications and was released 3 days after delivery. CONCLUSION: A thrombin-soaked uterine pack may successfully control lower uterine segment bleeding following delivery of a patient with a low-lying placenta. This technique offers the obstetrician another treatment option in selected cases of postpartum hemorrhage.- - - - - - - - - - ranking = 2keywords = previa (Clic here for more details about this article) |
9/10. placenta previa accreta with cervical involvement causing tenacious postpartum hemorrhage: a case report.Conservative treatment for placenta accreta has recently been popularly accepted even though serious postpartum hemorrhage, resulting in maternal death, may occur. We report a case of placenta previa accreta with cervical involvement resulting in tenacious postpartum hemorrhage. A 28-year-old pregnant woman, gravida-2 para-1, who had undergone a previous cesarean section, was scheduled for a repeat cesarean section because of complete placenta previa associated with placenta accreta. The patient underwent cesarean section and delivered a 3,700 g, male infant. Manual removal of the placenta was performed with some difficulty and redundant placental tissue remained adhered to the uterine wall. oxytocin, ergometrine, uterine arterial ligation and packing of the lower uterine segment were used to control bleeding; the wound was closed as usual after achieving adequate hemostasis. While closing the abdominal wall, vaginal bleeding was noted. After conservative treatment, shock progressively emerged due to persistent vaginal bleeding. Emergency laparotomy found active bleeding from the cervix and total abdominal hysterectomy was performed without hesitation. Careful evaluation is mandatory to preserve the uterus. In the case of cervical involvement, aggressive treatment such as hysterectomy should be undertaken promptly to decrease the risks of both morbidity and mortality.- - - - - - - - - - ranking = 6keywords = previa (Clic here for more details about this article) |
10/10. placenta accreta: MRI antenatal diagnosis and surgical correlation.We describe a case of a placenta previa accreta that was diagnosed antenatally by MRI with subsequent surgical confirmation. We show the advantages of ultrafast MRI single shot (SS) fast spin echo (FSE) techniques for accurate diagnosis with minimal scan time and fetal motion artifacts.- - - - - - - - - - ranking = 1keywords = previa (Clic here for more details about this article) |
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