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Comparison of cell salvage with one and two suction devices during cesarean section in patients with placenta previa and/or accrete: a randomized controlled trial

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Chinese Medical Journal 2020年第6期133卷 638-643页

作者： Hong Chen Hua Tan Pei-Xin Luo Yi-Fang Shen Chang-Cheng Lyu Xiao-Wei Qian Xin-Zhong Chen Department of Anesthesia Women's HospitalZhejiang University School of MedicineHangzhouZhejiang 310006China Department of Clinical Laboratory Women's HospitalZhejiang University School of MedicineHangzhouZhejiang 310006China

Background:Cell salvage has recently been recommended for obstetric use in cases with a high risk of massive hemorrhage during cesarean section(CS).However,limited data are available to support the use of one suction device to collect lost blood.This study aimed to investigate the volume of red blood cells(RBCs)salvaged and the components of amniotic fluid(AF)in blood salvaged by one suction device or two devices during CS in patients with placenta previa and/or accrete.Methods:Thirty patients with placenta previa and/or accrete undergoing elective CS in the Women's Hospital of Zhejiang University School of Medicine were recruited for the present study from November 1,2017 to December 1,2018.The patients were randomly assigned to one of the two groups according to an Excel-generated random number sheet:Group 1(w=15),in which only one suction device was used to aspirate all blood and AF,and Group 2(w=15),in which a second suction device was mainly used to aspirate AF before the delivery of the placenta.Three samples of blood per patient(pre-wash,post-wash,and post-filtration)were collected to measure AF components.The salvaged RBC volumes were recorded.Continuous data of pre-wash,post-wash,and postfiltration samples were analyzed by using one-way analysis of variance with Tukey5s test for multiple comparisons,or Kruskal-Wallis test with Dunn test for multiple comparisons.Comparisons of continuous data between Group 1 and Group 2 were conducted using Student's t test or Mann-Whitney U test.Results:The salvaged RBC volume was significantly higher in Group 1 than that in Group 2(401.6±77.2 mL vs.330.1土53.3 mL,?=4.175,P<0.001).In both groups,squamous cells,lamellar bodies,and fat were significantly reduced by washing(all P<0.001)and squamous cells were further reduced by filtering(P<0.001).Squamous cells were found in six post-filtration samples(three from each group).Lamellar bodies and fat were completely removed by filtering.Insulin-like growth factor binding protein 1,alphafetoprotein,albumin,lactate dehydrogenase

关键词： Cell salvage Blood transfusion Placenta previa Placenta accrete Cesarean section

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Uterine Artery Embolization for Management of Primary Postpartum Hemorrhage Associated with Placenta Accreta

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Chinese Medical Sciences Journal 2016年第4期31卷 228-232页

作者： Zhi-wei Wang Xiao-guang Li Jie Pan Xiao-bo Zhang Hai-feng Shi Ning Yang Zheng-yu Jin Department of Radiology Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical College

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.

关键词： uterine artery embolization postpartum hemorrhage placenta accrete

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The Usefulness of Zhukovsky Double Balloon in Obstetric Hemorrhage

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Maternal-Fetal Medicine 2019年第1期1卷 10-17页

作者： Sergey V.Barinov Irina V.Medyannikova Anna V.Borisova Yulia I.Tyrskaya Irina V.Savelieva Inna V.Shamina Oksana V.Lazareva Tatyana V.Kadtsyna The Second Department of Obstetrics and Gynaecology Federal State Budget Institution of HigherProfessional EducationOmsk State Medical Universitythe Russian Ministry of HealthcareOmsk644043Russia Department of Obstetrics and Gynaecology Federal State Budget Institution ofHigher EducationPeoples'Friendship Universitythe Russian Ministry of HealthcareMoscow117198Russia

Objective:To evaluate the effectiveness of the use of a modified Zhukovsky double(vaginal and uterine)balloon to improve the results of treatment in women with obstetric hemorrhage.Methods:We conducted an observational controlled study including 701 puerperas,which were divided into two groups:The main group consisted of 508 women,who underwent a combined management,that is,traditional(transfusion of fresh frozen plasma,erythrocyte mass,uterotonics,hemostatic agents),surgical hemostasis in cases of caesarean section,and insertion of a double Zhukovsky balloon;while the comparison group included 193 patients,who were managed traditionally.The main group and the comparison group were divided into subgroups according to the main etiology of obstetric hemorrhage:ⅠA andⅠB-postpartum;ⅡA andⅡB-placenta accreta;ⅢA andⅢB-postpartum hysterectomy.Results:The most frequent causes of massive obstetric hemorrhage were atony of the uterus(39.2%),placenta previa(29.1%),and placental abruption(11.5%).Of the 508 balloon insertions,345(70.7%)were inserted for hemorrhage during cesarean section and 148(29.3%)for obstetric hemorrhage after spontaneous delivery.Among the obstetric hemorrhage at caesarean section,lower segment bleeding prevailed(78.1%),caused mainly by placenta previa,placenta accreta,placental abruption,polyhydramnios,and uterine scar defects.Combined management,including surgical hemostasis and insertion of vaginal and uterine balloon of Zhukovsky,reduced blood loss by 1.5 times and the number of hysterectomies by 6.72 times compared to controls.Conclusion:The use of a modified Zhukovsky double balloon in the management of obstetric hemorrhage may reduce the number of hysterectomies and the amount of blood loss.

关键词： Obstetric hemorrhage Placenta previa accrete Vaginal wall rupture Uterine ligation Hypotonic hemorrhage

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植入性胎盘30例发病因素和治疗方式的选择

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当代医学 2012年第15期18卷 97-98页

作者：张姣娥岳阳市广济医院 414000

目的探讨引起植入性胎盘的原因及对该病的临床处理措施。方法选取2009年5月～2011年5月收治并确诊为植入性胎盘的30例产妇为研究对象,另选30例同期住院非植入性胎盘产妇行对照分析。结果观察组CK、AFP升高一倍者高于对照组:33.33%... 详细信息

目的探讨引起植入性胎盘的原因及对该病的临床处理措施。方法选取2009年5月～2011年5月收治并确诊为植入性胎盘的30例产妇为研究对象,另选30例同期住院非植入性胎盘产妇行对照分析。结果观察组CK、AFP升高一倍者高于对照组:33.33%、40%,差异经统计分析有意义。结论患者治疗期间,需积极预防感染,对出血量多者积极纠正贫血,维持生命体征平稳,提高产妇治愈率。

关键词： Placenta accrete 发病因素临床治疗

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