The cervix as a natural tamponade in postpartum hemorrhage caused by placenta previa and placenta previa accreta: a prospective study

Saad A A El Gelany, Ahmed R Abdelraheim, Mo'men M Mohammed, Mohammed T Gad El-Rab, Ayman M Yousef, Emad M Ibrahim, Eissa M Khalifa, Saad A A El Gelany, Ahmed R Abdelraheim, Mo'men M Mohammed, Mohammed T Gad El-Rab, Ayman M Yousef, Emad M Ibrahim, Eissa M Khalifa

Abstract

Background: Placenta previa and placenta accreta carry significant maternal and fetal morbidity and mortality. Several techniques have been described in the literature for controlling massive bleeding associated with placenta previa cesarean sections. The objective of this study was to evaluate the efficacy and safety of the use of the cervix as a natural tamponade in controlling postpartum hemorrhage caused by placenta previa and placenta previa accreta.

Methods: This prospective study was conducted on 40 pregnant women admitted to our hospital between June 2012 and November 2014. All participating women had one or more previous cesarean deliveries and were diagnosed with placenta previa and/or placenta previa accreta. Significant bleeding from the placental bed during cesarean section was managed by inverting the cervix into the uterine cavity and suturing the anterior and/or the posterior cervical lips into the anterior and/or posterior walls of the lower uterine segment.

Results: The technique of cervical inversion described above was successful in stopping the bleeding in 38 out of 40 patients; yielding a success rate of 95%. We resorted to hysterectomy in only two cases (5%). The mean intra-operative blood loss was 1572.5 mL, and the mean number of blood units transfused was 3.1. The mean time needed to perform the technique was 5.4 ± 0.6 min. The complications encountered were as follows: bladder injury in the two patients who underwent hysterectomy and wound infection in one patient. Postoperative fever that responded to antibiotics occurred in 1 patient. The mean duration of the postoperative hospital stay was 3.5 days

Conclusions: This technique of using the cervix as a natural tamponade appears to be safe, simple, time-saving and potentially effective method for controlling the severe postpartum hemorrhage (PPH) caused by placenta previa/placenta previa accreta. This technique deserves to be one of the tools in the hands of obstetricians who face the life-threatening hemorrhage of placenta accreta.

Trial registration: ClinicalTrials.gov NCT02590484 . Registered 28 October 2015.

Figures

Fig. 1
Fig. 1
Summary of the steps of the technique of cervical inversion. a: The placental bed showing significant bleeding. b: The inverted cervical lips grasped by 2 Allis forceps. c: The inverted cervical lips with Hegar dilator in between. d: Suturing the posterior cervical lip to the posterior wall of the lower uterine segment. e: Suturing the anterior cervical lip to the anterior wall of the lower uterine segment. f: The end of the procedure with the dilator being removed from the cervical canal

References

    1. Hwu YM, Chen CP, Chen HS, Su TH. Parallel vertical compression sutures: a technique to control bleeding from placenta praevia or accreta during cesarean section. Bjog. 2005;112:1420–3. doi: 10.1111/j.1471-0528.2005.00666.x.
    1. Russo M, Krenz EI, Hart SR, Kirsch D. Multidisciplinary approach to the management of placenta accreta. Ochsner J. 2011;11:84–8.
    1. Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline No. 27: Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management. London: RCOG; 2011.
    1. Vahdat M, Mehdizadeh A, Sariri E, Chaichian S, Najmi Z, Kadivar M. Placenta percreta invading broad ligament and parametrium in a woman with two previous cesarean sections: a case report. Case Rep Obstet Gynecol. 2012;251381.
    1. Tikkanen M, Stefanovic V, Paavonen J. Placenta previa percreta left in situ - management by delayed hysterectomy: a case report. J Med Case Rep. 2011;5:418. doi: 10.1186/1752-1947-5-418.
    1. Chandraharan E, Rao S, Belli AM, Arulkumaran S. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int J Gynaecol Obstet. 2012;117:191–4. doi: 10.1016/j.ijgo.2011.12.005.
    1. Garmi G, Salim R. Epidemiology, etiology, diagnosis, and management of placenta accreta. Obstet Gynecol Int. 2012;873929.
    1. O’Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J ObstetGynecol. 1996;175:1632–8. doi: 10.1016/S0002-9378(96)70117-5.
    1. Al-Harbi NA, Al-Abra ES, Alabbad NS. Utero-vaginal packing. Seven years review in the management of postpartum hemorrhage due to placenta previa/accreta at a maternity hospital in Central Saudi Arabia. Saudi Med J. 2009;30:243–6.
    1. Frenzel D, Condous GS, Papageorghiou AT, McWhinney NA. The use of the “tamponade test” to stop massive obstetric haemorrhage in placenta accreta. Bjog. 2005;112:676–7. doi: 10.1111/j.1471-0528.2005.00491.x.
    1. B-Lynch C, Coker A, Lawal AH, Abu I, Cowen MJ. The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol. 1997;104:372–5. doi: 10.1111/j.1471-0528.1997.tb11471.x.
    1. Tjalma WA, Jacquemyn Y. Compression sutures instead of emergency peripartum hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2005;118:258. doi: 10.1016/j.ejogrb.2004.07.032.
    1. Clark SL, Phelan JP, Yeh SY, Bruce SR, Paul RH. Hypogastric artery ligation for obstetric hemorrhage. Obstet Gynecol. 1985;66:353–6.
    1. Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997;177:210–4. doi: 10.1016/S0002-9378(97)70463-0.
    1. Nishijima K, Shukunami K, Arikura S, Kotsuji F. An operative technique for conservative management of placenta accreta. Obstet Gynecol. 2005;105:1201–3. doi: 10.1097/.
    1. Dawlatly B, Wong I, Khan K, Agnihotri S. Using the cervix to stop bleeding in a woman with placenta accreta: a case report. Bjog. 2007;114:502–4. doi: 10.1111/j.1471-0528.2006.01189.x.
    1. Bouwmeester FW, Jonkhoff AR, Verheijen RH, Van Geijn HP. Successful treatment of life-threatening postpartum hemorrhage with recombinant activated factor VII. Obstet Gynecol. 2003;101:1174–6. doi: 10.1016/S0029-7844(03)00350-8.
    1. American College of Obstetricians and Gynecologists. ACOG committee opinion. Placenta accreta. Number 266, January 2002. Int J Gynaecol Obstet. 2002;77(1):77–78. DOI: 10.1016/S0020-7292(02)80003-0
    1. Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. 2006;107:927–41. doi: 10.1097/01.AOG.0000207559.15715.98.
    1. Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F, et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol. 2010;115:526–34. doi: 10.1097/AOG.0b013e3181d066d4.
    1. Clement D, Kayem G, Cabrol D. Conservative treatment of placenta percreta: a safe alternative. Eur J Obstet Gynecol Reprod Biol. 2004;114:108–9. doi: 10.1016/j.ejogrb.2003.06.008.
    1. Bodner LJ, Nosher JL, Gribbin C, Siegel RL, Beale S, Scorza W. Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta. Cardiovasc Intervent Radiol. 2006;29:354–61. doi: 10.1007/s00270-005-0023-2.
    1. El-Bialy G, Kassab A, Armstrong M. Magnetic resonance imagining (MRI) and serial beta-human chorionic gonadotrophin (beta-hCG) follow up for placenta percreta. Arch Gynecol Obstet. 2007;276:371–3. doi: 10.1007/s00404-007-0351-3.
    1. Sakhavar N, Heidari Z, Mahmoudzadeh-Sagheb H. Cervical inversion as a novel technique for postpartum hemorrhage management during cesarean delivery for placenta previa accreta/increta. Int J Gynaecol Obstet. 2015;128(2):122–5. doi: 10.1016/j.ijgo.2014.08.020.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren