When is the ideal time to remove cerclage in cases requiring cesarean hysterectomy for placenta accreta spectrum?

Placenta accreta spectrum (PAS) presents one of the highest risks to pregnancy and often requires a cesarean hysterectomy for management, but the challenges associated with this surgery often cause severe obstetric haemorrhaging and high rates of maternal morbidity. Shirodkar cerclage is usually performed in cases with cervical insufficiency, a short cervix with previous preterm birth, etc., to decrease the preterm birth rate. It is recommended that Shirodkar cerclage is removed when the patient approaches term, but the ideal timing of removal for patient for whom cesarean hysterectomy is planned is not clear. Here, authors present a case of PAS in whom Shirodkar cerclage that was difficult to remove at the timing of cesarean hysterectomy. After cesarean hysterectomy, the patient had a vaginal abscess and required antibiotic therapy for approximately two weeks. In the light of our case, authors discuss the timing of removal of cerclage in the cases of PAS.

Influence of ethanol-induced pulmonary embolism on hemodynamics in pigs.

Aims and Objectives: Ethanol is widely used for the embolization treatment of vascular malformations, but it can also cause serious complications such us pulmonary hypertension, cardiopulmonary collapse and death. The complications are considered secondary to pulmonary vasospasm and ethanol‑induced sludge embolism, etc., We studied the hemodynamic effects of intravenous absolute ethanol injection and ethanol sludge injection in pigs. Materials and Methods: A total of 5 pigs underwent intravenous injection of ex vivo generated ethanol‑induced sludge in which residual ethanol was removed (Group S) and 4 pigs underwent intravenous injection of absolute ethanol (Group E). Hemodynamic parameters related to the pulmonary and systemic circulation were compared between the groups. Results: Transient pulmonary hypertension was observed in both groups and the hemodynamic changes were similar in both groups. Conclusions: Sludge can induce transient pulmonary hypertension or cardiopulmonary collapse, without ethanol and may be the mechanism by which ethanol induces its adverse hemodynamic effects.