1/7. Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience.OBJECTIVE: Obstetric hemorrhage is a significant cause of maternal morbidity and death. postpartum hemorrhage that cannot be controlled by local measures has traditionally been managed by bilateral uterine artery or hypogastric artery ligation. These techniques have a high failure rate, often resulting in hysterectomy. In contrast, endovascular embolization techniques have a success rate of >90%. An additional benefit of the latter procedure is that fertility is maintained. We report our experience at Stanford University Medical Center in which this technique was used in 6 cases within the past 5 years. STUDY DESIGN: Six women between the ages of 18 and 41 years underwent placement of arterial catheters for emergency (n = 3) or prophylactic (n = 3) control of postpartum bleeding. Specific diagnoses included cervical pregnancy (n = 1), uterine atony (n = 3), and placenta previa and accreta (n = 2). RESULTS: Control of severe or anticipated postpartum hemorrhage was obtained with transcatheter embolization in 4 patients. A fifth patient had balloon occlusion of the uterine artery performed prophylactically, but embolization was not necessary. In a sixth case, bleeding could not be controlled in time, and hysterectomy was performed. The only complication observed with this technique was postpartum fever in 1 patient, which was treated with antibiotics and resolved within 7 days. CONCLUSIONS: uterine artery embolization is a superior first-line alternative to surgery for control of obstetric hemorrhage. Use of transcatheter occlusion balloons before embolization allows timely control of bleeding and permits complete embolization of the uterine arteries and hemostasis. Given the improved ultrasonography techniques, diagnosis of some potential high-risk conditions for postpartum hemorrhage, such as placenta previa or accreta, can be made prenatally. The patient can then be prepared with prophylactic placement of arterial catheters, and rapid occlusion of these vessels can be achieved if necessary.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. A hypothesis to explain the occurence of inner myometrial laceration causing massive postpartum hemorrhage.BACKGROUND: Inner myometrial lacerations were found in three patients who developed uncontrollable postpartum massive bleeding despite the usual treatment for uterine atony. Because all the patients suffered from hemorrhage shock and their medical status deteriorated, their uteri were surgically removed to stop bleeding. After removal, one of them died. postpartum hemorrhage was caused by inner myometrial laceration. We hypothesized a cause of inner myometrial laceration, using the three resected uteri, an assumed model of the uterine body, and 34 women. methods: The subjects were 37 women, of whom three were patients with inner myometrial laceration, 23 were women without inner myometrial laceration who underwent cesarean section, and 11 were women in the first stage of labor. The three resected uteri were examined both macroscopically and microscopically. We measured the thickness of the wall of the uterine muscle at the widest point of the uterine corpus and the thickness of the myometrial wall at a transverse section of the uterine cervix, as well as the radius of the inner lumen at the widest point of the uterus in 23 women during cesarean section. We also measured the thickness of the myometrial wall at the widest point of the uterine corpus in 11 women at the end of the first stage of labor during ultrasonic examination. The data were then used to estimate the stress on the uterine muscle. RESULTS: The stress on the uterine cervix was stronger than that on the uterine corpus during labor. When the stress on the uterine muscle is stronger than a specific value, inner myometrial lacerations develop on the right and/or left side of the uterine cervix. These lacerations may involve large vessels. CONCLUSIONS: We have discovered another cause of postpartum hemorrhage which we have named inner myometrial laceration. These lacerations appeared to result from a strong stress on the uterine cervix caused by an abnormal rise in intrauterine pressure during labor.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/7. Failure of conservative management of placenta previa-percreta.We present a patient with a placenta previa in which we failed to manage conservatively with methotrexate and uterine embolization. The patient was diagnosed in the second trimester as having a possible placenta previa-increta,and underwent a repeat classical cesarean delivery at 32 weeks of gestation due to significant antepartum vaginal bleeding. Following abdominal closure,the uterine vessels were embolized with the Gel-Foam by interventional radiology. The placenta previa was left in-situ and patient was discharged home in stable condition in five days. The patient reported on the 44th postoperative day with heavy vaginal bleeding. A total abdominal hysterectomy was performed due to an unstable patient's hemodynamic condition in association with fluid resuscitation and multiple blood transfusions. The pathologic findings revealed a 675 g uterus with placenta previa-percreta with extension of chorionic villi to the serosal layer. Our case demonstrates a need for careful selection of patients with placenta previa and suspected accreta/increta/percreta that would be suitable candidates for conservative medical management. patients who opt for conservative medical management should be informed about the possibility of catastrophic bleeding associated with a retained placenta, that would ultimately require blood transfusions and hysterectomy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/7. prenatal diagnosis of vasa previa through color Doppler and three-dimensional power Doppler ultrasonography. A case report.vasa previa occurs in pregnancy when one of the membrane vessels extends down to the level of the internal cervical os, ahead of the fetal presenting part and unsupported by the placenta tissue or umbilical cord. The rupture of the vessels might happen spontaneously or artificially and frequently results in fetal exsanguination and demise. Ultrasound prenatal diagnosis is highly important as it allows the identification of patients at risk, thus an elective cesarean can be performed before rupture the membranes. We report a case of vasa previa diagnosed through color Doppler mode in the 30th week of gestation, emphasizing the contribution of three-dimensional power Doppler to the adequate mapping of aberrant vessels, which greatly contributed to the success of the perinatal result.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
5/7. Occult infiltrating placenta previa percreta: an unusual case highlighting the management problems in a young patient.placenta previa in association with placenta accreta has been recorded on average in 1 in 500 pregnancies; its association with placenta percreta is a much rarer condition. We report an unusual case of placenta previa which presented as a severe form of occult parasitic infiltration, invading the internal iliac vessels. This was followed by life-threatening complications, despite preventative measures. Use of a prediction index to suspect placenta previa is mentioned.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/7. Sudden death following cesarean section for placenta previa and accreta.A case of disseminated intravascular coagulation (DIC) in a young woman after cesarean section for placenta previa and accreta is presented. Evidence of extensive pulmonary embolization by trophoblastic tissue, together with microthrombi in the cerebral and pulmonary blood vessels, is found at autopsy. awareness of this syndrome and prompt action are necessary to prevent tragic consequences.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/7. Use of transvaginal color Doppler ultrasound to diagnose vasa previa.vasa previa, though rare (1 in 3000 births), has a significantly high mortality rate. Diagnosis is usually difficult, especially during the antenatal period. However, the use of transvaginal color Doppler ultrasound has increased the recognition of this condition during the antenatal period. Transvaginal color Doppler ultrasound is a more accurate way to view the vulnerable vessels in the area of question. This diagnostic tool will assist in the management of the patient to prevent possible disaster. In this report, transvaginal color Doppler ultrasound helped to recognize and follow up a patient with vasa previa to ensure a successful outcome for both the mother and the fetus. As the antenatal diagnosis of the condition increases with the use of transvaginal color Doppler ultrasound, the high mortality rate should decrease. The importance of meticulous evaluation of the placenta during routine obstetric ultrasound scanning is emphasized.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |