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.
Balloon Dilatation/*instrumentation ; Cesarean Section/adverse effects ; Postpartum Hemorrhage/etiology ; Postpartum Hemorrhage/*therapy

Female ; Humans ; Hysterectomy ; Postpartum Hemorrhage/therapy* ; Postpartum Period ; Risk Assessment ; Treatment Outcome ; Uterine Balloon Tamponade

OBJECTIVETo observe the effect of moxibustion at Sanyinjiao (SP 6) on delivery stage of primipara.

METHODSSixty cases of primipara were divided into a moxibustion at Sanyinjiao group, a non-acupoint group and a blank group. When the diameter of wormb mouth opened to 2-3 cm, showing that it entered into active stage of uterine contraction, moxibustion at Sanyinjiao (SP 6) for primipara was applied in moxibustion at Sanyinjiao group; moxibustion was applied at 1 cun towards radialis from the region where 2 cun above Kongzui (LU 6) in non-acupoint group, 30 minutes treatment was for both groups. There was no intervention in blank group. After delivery, the time of first,second and third delivery stages and postpartum bleeding 2 hours after delivery were compared among three groups.

RESULTSThe active duration of first delivery stage in moxibustion at Sanyinjiao group was significantly shorter than that in the other two groups (P < 0.05, P < 0.01); the duration of the second delivery stage in moxibustion at Sanyinjiao group was significantly shorter than that in the other two groups (both P < 0.05) as well; the postpartum bleeding 2 hours after delivery in moxibustion at Sanyinjiao group was less than other two groups and the difference was statistic significant between moxibustion at Sanyinjiao group and blank group (P < 0.05).

CONCLUSIONBy moxibustion at Sanyinjiao (SP 6), the active duration of first delivery stage and the duration of second delivery stage are markedly shortened, postpartum bleeding 2 hours after delivery is obviously reduced, and the safety of vaginal delivery is increased.

Acupuncture Points ; Adult ; Delivery, Obstetric ; Female ; Humans ; Labor Onset ; Moxibustion ; Postpartum Hemorrhage ; therapy ; Pregnancy ; Young Adult

Pregnancy ; Female ; Humans ; Postpartum Hemorrhage/therapy* ; Balloon Occlusion ; Hysterectomy ; Treatment Outcome

Gestational trophoblastic tumor is one of the curable disease, but metastatic trophoblastic tumor still shows high mortality rate because of resistance to the chemotherapy. Choriocarcinoma may occur after an any type of human pregnancy. The incidence of choriocarcinoma following term pregnancy is very uncommon, and such tumor appears to follow a more aggressive course with more extensive metastatic spread and is less responsive to chemotherapy resulting in a poorer prognosis. Choriocarcinoma presenting as postpartum hemorrhage, and spontaneous tumor perforation with intra-abdominal hemorrhage is even rarer, requiring emergency laparotomy. We had experienced one case of metastatic choriocarcinoma following term pregnancy that required emergency total abdominal hysterectomy due to uterine perforation and hemorrhage. So, we report this case with brief review of literatures.
Choriocarcinoma* ; Drug Therapy ; Emergencies ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Laparotomy ; Mortality ; Postpartum Hemorrhage ; Pregnancy ; Pregnancy* ; Prognosis ; Trophoblastic Neoplasms ; Uterine Perforation*

Objective To evaluate the efficacy and safety of uterine artery embolization (UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical records of patients with placenta accreta between January 2010 and August 2014. Totally 18 women (mean age 30.8±4.2 years) of primary massive postpartum hemorrhage with diagnosis of placenta accrete received treatment of UAE after delivery. Images of DSA and medical records were reviewed. Technical success was defined as control of bleeding after embolization. The complications, control of hemorrhage and recurrent bleeding of the placenta left inside the uterus were retrospectively collected for assessment. Results All patients underwent transcatheter embolization of bilateral uterine arteries. The technical success rate of embolization was 100%. Bleeding was controlled in 17 of 18 patients (94%) during follow-up period (median 18 months, 3-31months) without further bleeding recurred. One patient with placenta percreta undertook an emergent hysterectomy along with surgical bladder repair after UAE because of persistent uterine bleeding. Eight patients had postembolization syndrome and no other complications occurred. Conclusion Uterine artery embolization is an effective and safe treatment for the management of primary postpartum massive hemorrhage associated with placenta accreta.
Adult ; Female ; Humans ; Placenta Accreta ; therapy ; Postpartum Hemorrhage ; therapy ; Pregnancy ; Retrospective Studies ; Uterine Artery Embolization ; adverse effects

BACKGROUNDThe reports on massive transfusions (MTs) in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe postpartum hemorrhage (PPH) and the frequency trends over the past 10 years.

METHODSWe retrospectively analyzed the data of 3552 PPH patients who were at ≥28 weeks of gestation in the Obstetric Department of Peking University First Hospital from January 2006 to February 2015. The clinical records of patients receiving MT with ≥5 units (approximately 1000 ml) of red blood cells within 24 h of giving birth were included. The Pearson's Chi-square and Fisher's exact tests were used to compare the frequency distributions among the categorical variables of the clinical features.

RESULTSOne-hundred six women were identified with MT over the 10-year period. The MT percentage was stable between the first 5-year group (2006-2010) and the second 5-year group (2011-2015) (2.5‰ vs. 2.7‰, χ2 = 154.85, P = 0.25). Although uterine atony remained the main cause of MT, there was a rising trend for placental abnormalities (especially placenta accreta) in the second 5-year group compared with the first 5-year group (34% vs. 23%, χ2 = 188.26, P = 0.03). Twenty-four (23%) women underwent hysterectomy, and among all the causes of PPH, placenta accreta had the highest hysterectomy rate of 70% (17/24). No maternal death was observed.

CONCLUSIONSThere was a rising trend for placental abnormalities underlying the stable incidence of MT in the PPH cases. Placenta accreta accounted for the highest risk of hysterectomy. It is reasonable to have appropriate blood transfusion backup for high-risk patients, especially those with placenta accreta.

Adult ; Blood Transfusion ; Female ; Humans ; Hysterectomy ; Placenta Accreta ; physiopathology ; Postpartum Hemorrhage ; diagnosis ; etiology ; therapy ; Pregnancy ; Retrospective Studies ; Risk Factors

A 46-year-old Vietnamese woman received embolization therapy in order to control postpartum hemorrhage. Angiography revealed an aberrant ovarian artery arising from the right common iliac artery. Superselective catheterization and subsequent embolization of the aberrant ovarian artery and bilateral uterine arteries were performed. Precise knowledge of the anatomic variations of the ovarian artery is important for successful embolization.
Angiography ; Embolization, Therapeutic/*methods ; Female ; Humans ; Iliac Artery/*radiography ; Middle Aged ; Ovary/*blood supply/*radiography ; Postpartum Hemorrhage/*radiography/*therapy ; Pregnancy ; Vascular Malformations/*radiography/*therapy

OBJECTIVETo investigate the clinical features and treatment of placenta previa complicated with previous caesarean section.

METHODSThe clinical data of 29 patients with placenta previa complicated with a previous caesarean section (RCS group) admitted in Peking Union Medical College Hospital during a period from 2003 to 2011 were retrospectively reviewed and compared with those of 243 patients with placenta previa without a previous caesarean section (FCS group) during the same period.

RESULTSThere was no difference in the mean age (28.9±3.6 vs.28.1±4.5 years) and the average gravidity (2.35±1.48 vs.2.21±1.53) between RCS group and FCS group (all P>0.05).The RCS group had more preterm births (24.1% vs.13.2%), complete placenta previa (55.2% vs.4.9%), placenta accreta (34.5% vs.2.5%), more blood loss during caesarean section (1412±602 vs.648±265 mL), blood transfusion (51.7% vs.4.9%), disseminated intravascular coagulation (13.8% vs.2.1%), and obstetric hysterectomy (13.8% vs.0.8%) than the FCS group (all P<0.05).The preterm infant rate (30.0% vs.13.0%), neonatal asphyxia rate (10.0% vs.4.9%), and perinatal mortality rate (6.7% vs.0.4%) of the RCS group were higher than those of the FCS group (all P<0.05).

CONCLUSIONSMore patients had complete placenta previa and placenta accreta, postpartum hemorrhage, transfusion, uterine packing, obstetric hysterectomy, and perinatal morbidity in the placenta previa patients with previous caesarean section.The patient should be informed of the risk and unnecessary first cesarean sections should be avoided.

Adult ; Cesarean Section ; adverse effects ; statistics & numerical data ; Female ; Humans ; Infant, Newborn ; Morbidity ; Placenta Accreta ; therapy ; Placenta Previa ; therapy ; Postpartum Hemorrhage ; etiology ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies

OBJECTIVETo explore the indication of hysterectomy after successful resuscitation of cardiac arrest due to obstetric hemorrhagic shock.

METHODSA retrospective analysis was conducted in 13 patients with cardiac arrest due to obstetric hemorrhagic shock in 7 hospitals of Guangzhou, including 12 patients undergoing hysterectomy and 1 undergoing uterine artery embolization.

RESULTSs After successful cardiopulmonary resuscitation, only 4 of the 13 patients undergoing hysterectomy or uterine artery embolization for continuing uterus hemorrhage survived.

CONCLUSIONDetailed plans and emergency measures should be formulated in the management of high-risk pregnancies. Early diagnosis and active treatment of obstetric hemorrhagic shock with hysterectomy or uterine artery embolization are critical in preventing cardiac arrest and improving the survival of the patients.

Adult ; Cardiopulmonary Resuscitation ; Female ; Heart Arrest ; etiology ; therapy ; Humans ; Hysterectomy ; Postpartum Hemorrhage ; surgery ; Pregnancy ; Retrospective Studies ; Shock, Hemorrhagic ; etiology ; therapy ; Young Adult