The fertility sparing management of postpartum hemorrhage: A series of 47 cases of Bakri balloon tamponade

Alkış, İsmet; Karaman, Erbil; Han, Ağahan; Ark, Hasan Cemal; Büyükkaya, Betül

doi:10.1016/j.tjog.2014.03.009

Cited by 29 publications

(17 citation statements)

References 19 publications

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“…PPH was defined as >500 mL estimated blood loss after a vaginal delivery, or >1000 mL after a CS. In our study, the blood loss was calculated by blood volume after delivery (PPH), including the intraoperative blood loss during CS or vaginal delivery, as presented in Table 1 [1].…”

Section: Dear Editormentioning

confidence: 99%

“…

First of all, our study included 47 cases of pregnant women who had postpartum hemorrhage (PPH), intractable to conservative medical management.

…”

mentioning

confidence: 96%

“…We appreciate Dr Wang's advice on our previous study [1] and his valuable review on this important topic. Dr Wang has pointed out several important issues, and we would like to respond and further discuss here.…”

mentioning

confidence: 96%

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Conservative management of postpartum hemorrhage

Karaman

Alkış

Han

et al. 2015

Taiwanese Journal of Obstetrics and Gynecology

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We appreciate Dr Wang's advice on our previous study [1] and his valuable review on this important topic. Dr Wang has pointed out several important issues, and we would like to respond and further discuss here.First of all, our study included 47 cases of pregnant women who had postpartum hemorrhage (PPH), intractable to conservative medical management. The majority of our patients underwent cesarean section (CS), and some of them had high risk for PPH. As per our hospital's policy, the preoperative strategy for high-risk patients includes the preparation of adequate blood-transfusion products and the availability of at least one senior consultant obstetrician who is able to manage PPH. Two recent articles have shown the effectiveness of uterine-vessel embolization; however, we think that predelivery embolization is not a good alternative to CS in the case of a pregnant woman with a healthy thirdtrimester pregnancy with placenta previa [2,3]. Similarly, the article by Huang et al [2] showed its effectiveness in the termination of pregnancy with placenta previa due to fetal death and serious fetal malformations at 22e29 weeks, or persistent vaginal bleeding at 21e22 weeks of pregnancy before viability. Therefore, it is obvious that predelivery embolization cannot be accepted for the pregnant woman who has a healthy third-trimester pregnancy. Also, our institution has no resources for embolization, and so we have no strategy for that kind of treatment. Nonetheless, we think that it can be a good alternative to CS in the case of pregnancy termination before viability, as stated by Huang et al [2]. In addition, iliac or uterine-artery ligation might also be considered in patients with PPH. However, these techniques need some surgical skills, especially for internal iliac-artery ligation, and also cause concern for some complications. In our study, the intraoperative strategy when dealing with PPH, either due to the uterine atony or abnormal placentation, included firstly the medical conservative treatment (uterine massage, uterotonics, and bimanual compression), and then applying the Bakri balloon tamponade (BBT). If the bleeding did not stop, the invasive procedure, including vessel ligation or uterine compression sutures, was performed, and if this failed finally, hysterectomy was performed. We agree with the report by Liu et al [4], and it seems rational to ligate the uterine artery in pregnant women with uterine leiomyomas, who are undergoing CS. Importantly, it should be suggested to perform ligation to the uterine artery (right or left) that provides the blood supply to the leiomyoma.Secondly, BBT should be applied when medical treatment fails to stop bleeding during delivery, either vaginal or CS, after exclusion of genital lacerations. This is the ideal time to perform BBT. We could not give the time interval between the occurrence of PPH and the insertion of BBT as the data from medical records were not available. However, consistent with our experience, we can say that it is more efficient to use BBT in CS t...

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Section: Dear Editormentioning

confidence: 99%

“…

First of all, our study included 47 cases of pregnant women who had postpartum hemorrhage (PPH), intractable to conservative medical management.

…”

mentioning

confidence: 96%

See 1 more Smart Citation

Conservative management of postpartum hemorrhage

Karaman

Alkış

Han

et al. 2015

Taiwanese Journal of Obstetrics and Gynecology

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“…PPH is the first direct leading cause of maternal deaths in developing countries. It is accountable for one-third of all pregnancy-related mortalities in Africa, Asia, and roughly 140,000 mortalities per year in Egypt [5][6][7]. The 3 rd stage prolongation is considered the first cause of PPH.…”

Section: Introductionmentioning

confidence: 99%

Effect of Placental Cord Drainage on the Third Stage of Labour Progress and Incidence of Postpartum Hemorrhage: Randomized Controlled Clinical Trial

Elgzar¹,

Ibrahim²,

Elkhateeb³

2020

SARJNHC

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Background: Postpartum hemorrhage (PPH) is accountable for around 25% of maternal mortality in the developing countries. Management of 3 rd stage of labour is the cornerstone in PPH prevention. The effect of Placenta Cord Drainage (PCD) on the 3 rd progress and PPH prevention is still controversy. Aim of the study: This study aims to investigate the effect of placental drainage on the third stage of labour progress and incidence of postpartum hemorrhage. Research design: randomized controlled clinical trial. Setting: This study is conducted at normal labour unit at Damanhour educational institution affiliated to ministry of health at Elbehira governorate/Egypt. Sampling: A purposive sample of 120 women undergoing normal easy vaginal delivery. Tools: two tools were used for data collection. Tool I: sociodemographic characteristics and obstetric history interview schedule. Tool II: Labour assessment sheet it consists of three main parts. Part I: Summary of the first and second stage of labor. Part II: third stage assessment sheet. Part III: 3. Early postpartum assessment sheet. Results: The present study results shows no statistical significant differences between PCD and control group regarding vital signs during the 3rd stage, uterus condition after placenta delivery, type, dose and route of uterotonic drugs given during 3rd stage. On the contrary, a statistical significant reduction in the time elapsed until appearance of placenta separation signs (3.5583±0.83915), 3rd stage duration(5.1417±1.03138), amount of blood loss during 3rd stage (195.45±13.994), placenta weight (580.333±64.97631) and incidence of retained placenta ((0%) in the PCD group than control. In the early postpartum assessment, the mean pulse (88.2.7667±3.11022) is higher among control group compared to PCD (83.4667±2.78292) group. Control group needs higher dose of uterotonic (8.6780±2.62902) drugs than PCD (5.0566±1.41985) group. In addition, maternal hemoglobin (9.5234±0.6087) is slightly higher in PCD group compared to control (8.458±0.873). Conclusion: PCD is safe, effective noninvasive intervention that may help in improving 3 rd stage progress. Recommendation: PCD should be added to third stage of labour intervention protocol.

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“…Separation of the placenta from the uterine wall is usually completed within 15 minutes in 90% of women after a fetal delivery (2,6). Prolongation of the TSL increases the development of PPH, which is responsible for one quarter of maternal deaths globally, one third of all pregnancy-related deaths in Africa and Asia, and approximately 140.000 deaths annually (7,8).…”

Section: Introductionmentioning

confidence: 99%

Placental Blood Drainage Shortens Duration of the Third Stage of Labor in Women Slowly Administered 20 IU Oxytocin

Kaba

Üstün

Eyı

et al. 2017

Gynecol Obstet Reprod Med

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OBJECTIVE: Prolongation of the third stage of labor may cause serious postpartum complications. Thus, timely expulsion of the placenta is essential for preventing complications of the third stage of labor. We conducted a prospective cohort study to determine the effect of placental cord drainage on the duration of the TSL in women administered intravenous oxytocin during this stage. STUDY DESIGN:This was a prospective cohort study in which 112 low risk pregnant women were allocated to the study. There were 53 women in the placental cord drainage group, and 59 women in the cord clamping group without drainage. Immediately after fetal delivery, intravenous infusion of 20 IU oxytocin in 500 mL Ringers' Lactate was started and infused within 2 hours in women in both groups. Outcome measures were the third stage duration and hemoglobin differences between admission and the postpartum sixth hour. RESULTS:There were no significant differences between the two groups with regard to duration of stages 1 and 2 of labor, hemoglobin level on admission, and at the postpartum sixth hour, and hemoglobin differences between admission and the postpartum sixth hour. The median third stage duration in the study group was 3.40 (range: 0.35-16.20) minutes, and 5.10 (range: 2.30-11.00) minutes in the control group. This difference between the groups was statistically significant (p<0.01). CONCLUSION:Placental cord drainage reduces the third stage duration following vaginal deliveries in patients receiving intravenous oxytocin. Placental cord drainage is simple, does not require additional cost, and is applicable for every delivery.Keywords: Third stage of labor, Active management of the third stage, Placental cord drainage,

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The fertility sparing management of postpartum hemorrhage: A series of 47 cases of Bakri balloon tamponade

Abstract: Uterine preservation is an important issue when managing PPH. BBT is an effective, easy to use, and safe procedure for massive PPH that can minimize recourse to hysterectomy after failed medical treatment.

Cited by 29 publications

References 19 publications

Conservative management of postpartum hemorrhage

Conservative management of postpartum hemorrhage

Effect of Placental Cord Drainage on the Third Stage of Labour Progress and Incidence of Postpartum Hemorrhage: Randomized Controlled Clinical Trial

Placental Blood Drainage Shortens Duration of the Third Stage of Labor in Women Slowly Administered 20 IU Oxytocin

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