Can the combination of internal iliac temporary occlusion and uterine artery embolization reduce bleeding and the need for intraoperative blood transfusion in cases of invasive placentation?

OBJECTIVES: Women with invasive placentation (IP) are at high risk of life-threatening hemorrhage. In the last two decades, less invasive surgical approaches combined with endovascular procedures have proven to be safe. Most case series describe the use of temporary balloon occlusion and embolization, either combined or not. Concerning hemorrhage rates, each separate interventional approach performs better than surgery alone does, yet it is not clear whether the combination of multiple interventional techniques can be beneficial and promote a lower incidence of intrapartum bleeding. We aim to evaluate whether combining temporary balloon occlusion of the internal iliac artery and uterine artery embolization promotes better hemorrhage control than do other individual interventional approaches reported in the scientific literature in the context of cesarean birth followed by hysterectomy in patients with IP. METHODS: This is a retrospective analysis of patients with confirmed IP who underwent temporary balloon occlusion and embolization of the internal iliac arteries followed by puerperal hysterectomy. We compared patient results to data extracted from a recent systematic review and meta-analysis of the current literature that focused on interventional procedures in patients with IP. RESULTS: A total of 35 patients underwent the procedure during the study period in our institution. The mean volume of packed red blood cells and the estimated blood loss were 487.9 mL and 1193 mL, respectively. Four patients experienced complications that were attributed to the endovascular procedure. CONCLUSION: The combination of temporary balloon occlusion and uterine artery embolization does not seem to promote better hemorrhage control than each procedure performed individually does.

Caracterización de la morbilidad materna extremadamente grave en la provincia de Camagüey (2009) / Characterization of extremely severe maternal morbidity in Camaguey province (2009)

Introducción: a través del control y análisis de la morbilidad materna extremadamente grave se adopta una forma acertada y precisa para evaluar el nivel de salud. Se considera un indicador muy asociado a la muerte materna: constituye una alternativa válida como indicador de la calidad de los cuidados maternos. Objetivo: caracterizar la morbilidad materna extremadamente grave en Camagüey. Métodos: se realizó un estudio descriptivo transversal, desde enero hasta diciembre del año 2009, con un universo de 72 pacientes que fueron diagnosticadas como morbilidad materna extremadamente grave en los hospitales maternos de Camagüey y la Unidad de Cuidados Intensivos del Hospital Provincial, según criterios de clasificación. La información se obtuvo mediante la historia clínica de cada gestante durante su atención prenatal y hospitalaria. Resultados: el grupo etario que prevaleció fue el de más de 35 años con 26,3 por ciento. Se identificaron 72 pacientes (93,0 por ciento); como morbilidad materna extremadamente grave, de ellas, el 65,3 por ciento llegaron al parto 34,7 por ciento no lo lograron por diferentes causas (embarazos ectópicos, abortos diferidos y angina de Ludwing). Se identificaron como riesgos que se destacan la malnutrición (38,8 por ciento), la edad extrema (35,1 por ciento), la hipertensión arterial(31,4 por ciento), la anemia (25,9 por ciento), la infección vaginal (22,2 por ciento) y la preeclampsia (16,6 por ciento). Conclusiones: el diagnóstico de esta entidad se realizó fundamentalmente durante el parto, y la hemorragia obstétrica es la principal causa de morbilidad(AU)

Introduction: through the control and analysis of extremely severe maternal morbidity, it is possible to evaluate the health status in an accurate and precise way. This indicator, closely associated to maternal death, is a valid alternative as a maternal care quality indicator. Objective: to characterize extremely severe maternal morbidity in Camaguey province. Methods: a cross-sectional descriptive study was conducted from January through December 2009 in a universe of 72 patients, who were diagnosed as extremely severe maternal morbidity in the maternal hospitals of Camaguey and in the intensive care unit of the provincial hospital, according to the classification criteria. Data were collected from the medical history of each pregnant woman during her prenatal and hospital care. Results: the prevailing age group was over 35 years accounting for 26.3 percent. Seventy two patients were classified as extremely severe maternal morbidity cases; 65.3 percent of them did give birth but 34.7 percent did not because of several causes (ectopic pregnancies, delayed abortions and Ludwig angina). The identified risks were malnutrition (38.8 percent), extreme age (35.1 percent), blood hypertension (31.4 percent), anemia (25.9 percent), vaginal infection (22.2 percent) and preeclampsia (16.6 percent). Conclusions: the condition was mostly diagnosed during delivery, being the obstetric hemorrhage the main cause of morbidity(AU)

[Evaluation of the risk factors related to dysfunctional uterine bleeding in peri-menopausal women in Sanandaj]

Dysfunctional uterine bleeding [DUB] is one of the common problems in peri-menopausal women that can affect their physical, emotional and social conditions. In addition DUB is one of the main causes of hysterectomy. The aim of this study was to investigate risk factors associated with DUB in peri-menopausal women in Sanandaj. This case-control study included 62 women with DUB[case group] and 124 women without DUB[control group]. We used a questionnaire consisted of different items which was completed for every subject after clinical interview. Using SPSS software, data analysis was performed by chi-square, Fisher exact test and logistic regression. DUB showed significant relationships with type of delivery [p=0.015] and age [p=0.045]. DUB had no significant relationship with diabetes [p=0.095], hypertension [p=0.917] and type of contraceptive methods [p=0.906]. Analysis by logistic regression revealed that women over 50 years of age and women with history of Cesarean section [C/S] had a respective risk of 2.284 [p=0.021] and 2.493 [p=0.009] times greater to develop DUB than women without these factors. The age over 50 years and C/S was suggested as risk factors which can be related to DUB. Attention to the advantages of vaginal delivery and complications of C/S is necessary and reduction of C/S rate can be effective in decreasing the incidence of DUB

Beneficios no anticonceptivos de 0, 02 mg de etinilestradiol/2 mg de acetato de clormadinona administrados en un régimen de 24+4 días / Non-contraceptive benefits of 0.02 mg ethinylestradiol /2 mg chlormadinone acetate in a 24 +4 days intake regimen

Objetivo: Demostrar la influencia sobre las molestias emocionales y físicas (beneficios no anticonceptivos) experimentadas durante el primer año de uso de un anticonceptivo oral combinado (AOC) que contiene 0,02 mg de etinilestradiol (EE) y 2 mg de acetato de clormadinona (ACM) administrado en un régimen de 24 + 4 días de placebo. Diseño del estudio: Análisis adicional de las sensaciones subjetivas registradas en los diarios de 1665 participantes de un estudio de Fase III multicéntrico, no controlado, de administración múltiple, después de 13 ciclos de EE/ACM en un régimen de administración de 24 + 4 días, publicado previamente. Resultados: Se informó de menor frecuencia de molestias emocionales y físicas en el ciclo de medicación 13 en comparación con los datos en la admisión y en el ciclo 1. La incidencia de ánimo depresivo se redujo en 84,5 por ciento y 72,2 por ciento respectivamente, y la irritabilidad en 87,3 por ciento y 66,0 por ciento. Las cefaleas se redujeron en 75,5 por ciento y 74,7 por ciento, las molestias mamarias en 77,1 por ciento y 66,1 por ciento, y la dismenorrea preexistente en 77,9 por ciento y 67,6 por ciento respectivamente. El abandono prematuro del estudio a causa de las molestias fue marginal, y el perfil del sangrado fue aceptable. Conclusiones: Un AOC de baja dosis que contiene 0,02 mg de EE + 2 mg de ACM, administrado en un régimen de 24 + 4 días, reduce significativamente la mayor parte de las molestias emocionales y físicas que se presentan durante los ciclos espontáneos de las mujeres, y se combina con un adecuado perfil de sangrado.

Objective: To demonstrate the influence on physical and psychological complaints during the first year of intake of the combined oral contraceptive (COC) 0.02 mg ethinylestradiol (EE)/2 mg chlormadinone acetate (CMA), administered in a regimen of 24 days of CMA/EE intake followed by 4 days of placebo intake. Study design: The subjective feelings of non-contraceptive benefits registered in women's diaries of 1,665 subjects participating in a multicentre, uncontrolled, multiadministration, Phase III trial, published elsewhere, were analyzed post-hoc after 13 cycles intake of EE/CMA in a 24 +4 days intake regimen. Results: Emotional complaints were reported less frequently at medication cycle 13 compared with admission and cycle 1. Depressive mood was reduced by 84.5 percent and 72.2 percent, irritability by 87.3 percent and 66.0 percent; physical complaints were also reduced: headaches by 75.5 percent and 74.7 percent, breast discomfort by 77.1 percent and 66.1 percent; pre-existing dysmenorrhea by 77.9 percent and 67.6 percent. Premature termination due to complaints was only marginal, the bleeding profile was accepted. Conclusions: The low-dose COC, 0.02 mg EE/2 mg CMA, administered in a 24 +4 day regimen, reduces significantly most of the emotional and physical complaints occurring during spontaneous cycles of women, combined with an adequate bleeding profile.

Randomized controlled trial of mefenamic acid vs paracervical block for relief of pain for outpatient uterine curettage.

OBJECTIVE: To compare the efficacy of mefenamic acid vs paracervical block for pain relief during and after fractional curettage. MATERIAL AND METHOD: Between January 1 and July 31, 2002, the authors enrolled 87 patients with abnormal uterine bleeding, who requested fractional curettage at the Outpatient Gynecologic Clinic, Srinagarind Hospital, Khon Kaen University. A simple randomization procedure was used to distribute the patients into a control group comprising 44 patients given a paracervical block and a treatment group comprising 43 patients given mefenamic acid (500 mg) 2 hours before starting the procedure. OUTCOME MEASURES: Pain was scored using a visual analogue scale (VAS range, 0 to 10). RESULTS: The median pain scores of the treatment types during endocervical, endometrial, immediately after, and 30 minutes after, fractional curettage were 2.5 vs 3.0 (p = 0.42), 6.5 vs 7.5 (p = 0.19), 4.0 vs 3.5 (p = 0.20) and 1.5 vs 1.0 (p = 0.17), respectively. The rate of complications was 6.8% (3 in 44) in the paracervical lignocaine injection group. CONCLUSION: The efficacy of pain relief for fractional curettage using oral mefenamic acid (500 mg) two hours before the procedure was not statistically different from the paracervical block, but there were fewer side effects. Mefenamic acid should be considered an alternate pain relief during fractional curettage.

Prevention and treatment of vaginal bleeding after drug-induced abortion by Yaoliuan capsule and its effects on menses recovery / 华中科技大学学报（医学）（英德文版）

In order to explore the effect of Yaoliuan capsule in the prevention and treatment of vaginal bleeding after drug-induced abortion and menses recovery after drug-induced abortion, 323 cases of gestation period < or = 49 days and without contraindication, were divided randomly into study group (168 cases, taking Yaoliuan capsule) and control group (155 cases, taking placebo capsule). The results showed that in the study group, there were 161 cases (95.8%) of complete abortion, 7 cases (4.2%) of incomplete abortion; In the control group, there were 146 cases (94.2%) of complete abortion, 6 cases (3.9%) of incomplete abortion, 3 cases (1.9%) of abortion failure. The vaginal bleeding time was 5-25 days (mean 10.8 days) in study group, while that was 6-62 days (mean 19.1 days) in control group. The menstrual cycle was 30.5+/-5. 2 days and 33.8 d+/-8.6 days respectively in study and control groups. The menstrual period was 6.1+/-3. 5 days and 9.9+/-5.1 days respectively in study and control groups. Yaoliuan capsule is an effective drug to prevent and treat vaginal bleeding following drug-induced abortion, promote menstruation recovery and prevent pelvic infection.

Study on the effects of FCu-IUD and FICu-IUD on matrix metalloproteinases in human uterine flushing and endometrium / 华中科技大学学报（医学）（英德文版）

The activity of matrix metalloproteinases (MMPs) in the uterine flushing and endometrial tissue of normal adult women wearing FCu-IUD (fixed Cu-IUD) or FICu-IUD (indomethacin-releasing FCu-IUD) was observed by using zymography on SDS-PAGE containing gelatin. The results showed that the activity and kinds of MMPs in FCu-IUD group were increased significantly as compared with themselves before being inserted FCu-IUD. However, compared with the FCu-IUD group, the activity of some kinds of MMPs in the FICu-IUD group was decreased significantly. These data suggest that IUD can enhance the activity of MMPs in human endometrium, intermediated by prostaglandins, and MMPs may have relation to IUD-induced menorrhagia and indomethacin reduces IUD-induced menorrhagia by partly inhibiting MMPs synthesis.

Preoperative Uterine Artery Embolization and Evacuation in the Management of Cervical Pregnancy: Report of Two Cases

Preoperative uterine artery embolization and cervical evacuation as conservative management of cervical pregnancy has been tried in recent years. However, cervical suturing, vasoconstrictor injection, or cervical ballooning was frequently used as an ancillary measures in those procedures in most of the previous studies. We report two cases of cervical pregnancy that were successfully treated with preoperative uterine artery embolization and removal of gestational material without ancillary procedures. Our therapeutic modality seems to be safe and effective for conservative management of cervical pregnancy.

Re-evaluation of uterine packing for postpartum haemorrhage

A retrospective study was conducted at the Department of Obstetrics and Gynaecology [Unit II], Liaquat Medical College Hospital, Jamshoro, Hyderabad, with the objective of determining the use of uterine packing for control of postpartum haemorrhage [PPH] and to evaluate the efficacy and complications of the procedure. Data was collected from the obstetric records of all the deliveries over a period of five years, from January 1992 to December 1996. All women who had undergone uterine packing for control of postpartum haemorrhage were identified and indications and postoperative complications analysed

Anaphylactoid transfusion reaction with anti-IgA antibodies in an IgA deficient patient: a case report.

A case of anaphylactoid transfusion reaction associated with anti-IgA antibodies is reported. The patient had low levels of serum IgA. She developed serious reaction characterised by erythematous rash, pruritus, cyanosis and dyspnoea after transfusion of otherwise compatible blood. Review of literature reveals that anaphylactoid transfusion reactions are very rare although frequency of anti-IgA in general population is quite high. The IgA deficient donors (aIgA) form a unique resource of blood components for the clinical management of patients with anaphylactoid reactions caused by anti-IgA.

Controle da hemorragia ginecológica e obstétrica por ligadura das artérias hipogástricas / Control of gynecologic and obstetric hemorrhage by hypogastric arteries ligation

A ligadura das artérias hipogástricas foi utilizada para controle de hemorragia ginecológica e obstétrica grave em cinco ocasiöes, no Hospital-Escola da Faculdade de Medicina do Triângulo Mineiro. Os cinco casos säo apresentados. Os autores ressaltam os aspectos técnicos, hemodinâmicos, fisiológicos, indicaçöes e complicaçöes deste procedimento.

Hemorragia uterina disfuncional en el Instituto Materno Infantil 1987-1988

Se analizaron 158 Historias Clínicas en forma retrospectiva de pacientes entre 16 y 60 años con diagnóstico de Hemorragia Uterina Disfuncional(HUD) que ingresaron por el Servicio de Admisión (Urgencias) del Hospital Materno Infantil de Bogotá entre el 1§ de arzo de 1986 y el 30 de septiembre del mismo año. De 942 consultas 354 (37.5 por ciento) correspondieron a HUD. Se analizaron previo estudio histopatológico 158 casos. De estos 114(72.15 por ciento) fueron de HUD y 44 (27.85 por ciento) a HUO. Al clasificar por grupos de edad se aprecia que las pacientes menores de 20 años, 5 (3.16 por ciento); entre 20 y 40 años 81(54.26 por ciento) y mayores de 40 años 72 (45.56 por ciento). Los diagnósticos definitivos para la HUD fueron E. Proliferativo 67 casos (58.8 por ciento); secretor 43( 37.7 por ciento) y Atrófico 2 (1.75 por ciento). Para la HUO: Endometritis 16 casos (36.4 por ciento) Hiperplasia Endometrial 13 (29.6 por ciento); restos ovulares 7 (15.9 por ciento); Ca. Endometrial 3 (6.8 por ciento) y Pólipos 2 ( 4.5 por ciento). El tratamiento de legradobiopsia fue eficaz en el 54 por ciento para el E. Proliferativo y 88.3 por ciento para el secretor. La terapéutica hormonal complementaria se llevó a cabo en el 40.5 por ciento de los casos de E. Proliferativo y 11.6 por ciento en E. Secretor. En la HUO, la Endometritis recibió tratamiento terapéutico en el 90 por ciento de los casos y en la hiperplasia 4 (30.7 por ciento) y quirúrgico 6 (46.1 por ciento). Se recomienda el legrado biopsia en pacientes con trastornos del ciclo para mayores de 40 años

Ligadura das artérias hipogástricas em ginecologia e obstetrícia / Hypogastric arteries ligation in gynecology and obstetrics

O sangramento em tocoginecologia é o principal responsável por uma alta taxa de mortalidade materna e por um grande número de histerectomias. No presente trabalho, os autores faze uma revisäo sobre o uso da ligadura das artérias hipogástricas no controle dessas hemorragias; descrevem a técnica, alteraçöes hemodinâmicas e complicaçöes do procedimento