Local injection of vasopressin reduces the blood loss during cesarean section in placenta previa

Abstract

The local injection of vasopressin into the placental implantation site significantly reduced the blood loss without increasing the morbidity.

Comparison of carbetocin and oxytocin infusions in reducing the requirement for additional uterotonics or procedures in women at increased risk of postpartum haemorrhage after Caesarean section

“…19 However, our results were inconsistent with the findings of a previous study, in which the additional effects of carbetocin were presumed to be trivial because of thinning in the lower uterine myometrium, thereby reducing the immunoreactivity of oxytocin receptors relative to the upper part of the uterus. 20 We noted that the significant differences in outcomes between treatments were mainly due to the contributions of the emergency Caesarean section group. Previous studies have largely demonstrated beneficial effects from carbetocin treatment in women undergoing elective Caesarean section, but not in women undergoing intrapartum Caesarean section.…”

Comparison between Placental Site Injection of Vasopressin and Bilateral Internal Iliac Artery Ligation to Reduce Blood Loss during Cesarean Section for Placenta Praevia : A Randomized Controlled Trial

“…If invasion extends into the myometrium, the term placenta increta is used; placental invasion beyond the uterine serosa (at times involving the bladder or other pelvic organs and vessels) is termed placenta percreta (5) . Cesarean delivery is essential in nearly all cases of placenta previa and the amount of blood loss during surgery is significantly higher than in cases of normal placental presentation, also the rate of blood transfusion was also significantly increased (6) . Different conventional approaches had been used to stop hemorrhage, including continuous uterine massage, uterine packing, and uterotonic agents, including oxytocin, prostaglandin and ergometrine.…”

“…Different conventional approaches had been used to stop hemorrhage, including continuous uterine massage, uterine packing, and uterotonic agents, including oxytocin, prostaglandin and ergometrine. However, in patients with placenta praevia , hemorrhage from the placental implantation site may continue after placental delivery because the lower uterine segment has poorer contraction than the uterine body (6) .There were multiple modalities that have been evolved to minimize blood loss during CS, which had directed towards reducing blood flow to the pelvis through bilateral ligation of internal iliac arteries or their branches (7) .Vasopressin is a naturally occurring hormone produced by magno-cellular neurons in para ventricular and supraoptic nuclei within the hypothalamus and secreted by the posterior lobe of the pituitary gland, where it is stored in granules present in the axon terminals (8) .…”

“…The vasopressin V1α receptor (VP1αR) has been demonstrated to be present in the myometrium of both non-pregnant and pregnant women and contributes to myometrial contraction (6) . In placenta praevia, bleeding is thought to be due to poor contraction of the lower uterine segment and the subsequent inability to compress the torn vessels (6) .The immune reactivity of oxytocin receptor was faint in the lower segment compared to the upper segment of the uterine body, which might contribute to the poor contractility of the lower segment and subsequent blood loss. However, immune reactivity of the vasopressin V1α receptor (VP1αR) was strongly localized to the smooth muscle cells obtained from both the upper and lower segments of the uterine body.…”

“…However, immune reactivity of the vasopressin V1α receptor (VP1αR) was strongly localized to the smooth muscle cells obtained from both the upper and lower segments of the uterine body. The reduction of blood loss after vasopressin injection into the placental implantation site may be caused by not only peripheral vasoconstriction, but also by contraction of uterine smooth muscle (6) .…”