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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

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

Authors: 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

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

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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
Appendix
Available only for authorised users
Literature
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.CrossRefPubMed
2.
Russo M, Krenz EI, Hart SR, Kirsch D. Multidisciplinary approach to the management of placenta accreta. Ochsner J. 2011;11:84–8.PubMedCentralPubMed
3.
4.
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.
5.
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.PubMedCentralCrossRefPubMed
6.
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.CrossRefPubMed
7.
Garmi G, Salim R. Epidemiology, etiology, diagnosis, and management of placenta accreta. Obstet Gynecol Int. 2012;873929.
8.
O’Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J ObstetGynecol. 1996;175:1632–8.CrossRef
9.
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.PubMed
10.
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.CrossRefPubMed
11.
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.CrossRefPubMed
12.
Tjalma WA, Jacquemyn Y. Compression sutures instead of emergency peripartum hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2005;118:258. author reply 258–9.CrossRefPubMed
13.
Clark SL, Phelan JP, Yeh SY, Bruce SR, Paul RH. Hypogastric artery ligation for obstetric hemorrhage. Obstet Gynecol. 1985;66:353–6.PubMed
14.
Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997;177:210–4.CrossRefPubMed
15.
Nishijima K, Shukunami K, Arikura S, Kotsuji F. An operative technique for conservative management of placenta accreta. Obstet Gynecol. 2005;105:1201–3.CrossRefPubMed
16.
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.CrossRefPubMed
17.
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.CrossRefPubMed
18.
19.
Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. 2006;107:927–41.CrossRefPubMed
20.
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.CrossRefPubMed
21.
Clement D, Kayem G, Cabrol D. Conservative treatment of placenta percreta: a safe alternative. Eur J Obstet Gynecol Reprod Biol. 2004;114:108–9.CrossRefPubMed
22.
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.CrossRefPubMed
23.
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.CrossRefPubMed
24.
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.CrossRefPubMed
Metadata
Title
The cervix as a natural tamponade in postpartum hemorrhage caused by placenta previa and placenta previa accreta: a prospective study
Authors
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
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0731-9

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