Acta obstetricia et gynecologica Scandinavica
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Acta Obstet Gynecol Scand · Oct 2010
New local hemostatic treatment for postpartum hemorrhage caused by placenta previa at cesarean section.
Cesarean section in women with placenta previa is associated with the risk of heavy bleeding. We describe a new method where local hemostasis is obtained by applying a hemostatic fleece directly onto the lower uterine segment. During a 2-year period women undergoing cesarean section due to placenta previa were treated with this hemostatic fleece if they had ongoing bleeding during the surgical procedure despite routine treatment. ⋯ No patients were readmitted to the hospital due to endometritis. We conclude that the application of a hemostatic fleece directly onto the bleeding surfaces in patients with post-cesarean bleeding due to placenta previa is technically unproblematic. The results suggest that this procedure should be considered in case of bleeding after delivery in women with placenta previa.
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Acta Obstet Gynecol Scand · Sep 2010
Perinatal variables and neonatal outcomes in severely growth restricted preterm fetuses.
To investigate the impact of severe preterm intrauterine growth restriction on perinatal and neonatal outcomes. ⋯ Despite intensive fetal surveillance and tertiary level neonatal care, the survival for growth restricted fetuses before 28 weeks gestation remains poor with neonatal outcome predominantly affected by respiratory morbidity, sepsis and metabolic compromise.
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Acta Obstet Gynecol Scand · Sep 2010
ReviewThe morbidly adherent placenta: an overview of management options.
Abstract Morbidly adherent placenta is often associated with severe maternal morbidity. An increased incidence over the recent years may be secondary to the increased cesarean section rates. Identification of patients with risk factors antenatally is essential for the early diagnosis and management. ⋯ Management aims to ensure a safe delivery of the fetus, alongside measures of prevention or effective management of postpartum hemorrhage. When a hysterectomy is performed, a multidisciplinary team with surgical expertise and facilities for transfusion and further interventions including arterial ligation and interventional radiology should be available. The options for conservative treatments offer the potential to preserve fertility but further research with prospective evaluation of the different approaches is necessary.
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Acta Obstet Gynecol Scand · Sep 2010
Conservative approach in heavy postpartum hemorrhage associated with coagulopathy.
The application of external uterine elastic bandage is a new approach to control serious postpartum hemorrhage. This was applied in 10 consecutive patients with severe postpartum hemorrhage. After circulatory stabilization by external aortic compression, laparotomy and identification of the source of bleeding, compression sutures were applied and intrauterine fibrin glue was administered. ⋯ Application of external uterine elastic bandage resulted in hemostasis within 45 minutes after aortic compression. Hysteroscopy 6 months after the procedure showed no signs of uterine ischemia or endometrial adhesions. In conclusion, external elastic uterine bandage is a simple tool that seems to improve hemostasis and prevent hysterectomy in heavy postpartum hemorrhage.
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Acta Obstet Gynecol Scand · Aug 2010
Randomized Controlled TrialEfficacy of intrauterine lignocaine plus vaginal misoprostol for pain relief in premenopausal women undergoing endometrial aspiration and ambulatory hysteroscopy.
To compare the effectiveness of a combination of intrauterine lignocaine and vaginal misoprostol in reducing pain at hysteroscopy and endometrial aspiration (EA). ⋯ A combination of intrauterine lignocaine plus vaginal misoprostol reduced the pain score in premenopausal women undergoing hysteroscopy and EA.