ABSTRACT
OBJECTIVE: To investigate efficacy of the BT-Cath(®) in cases of uncontrollable haemorrhage due to placenta previa. STUDY DESIGN: Retrospective study of women treated with the BT-Cath in the event of postpartum haemorrhage (PPH) due to placenta previa, despite optimal management with medical treatment. RESULTS: Between 2011 and 2013, 237 women had placenta previa (0.45%) at the study hospital. This study evaluated 53 women who underwent uterine tamponade with a BT-Cath. Haemostasis was achieved in 45 women (85%), and hysterectomy was required in six women (11%). Two women required repeat laparotomy. The mean duration of balloon tamponade was 9.8h (standard deviation 6.4h). When the relationship between balloon volume and treatment success was evaluated, the area under the receiver operating characteristic curve was 0.803 (95% confidence interval 0.633-0.973; p=0.007) and the optimal cut-off point was 220ml, with sensitivity of 88% and specificity of 71%. CONCLUSION: The intra-uterine BT-Cath is simple to use, even among clinicians with little experience, and is an effective treatment choice in patients with PPH due to placenta previa when medical treatment is unsuccessful. Minimal inflation of the balloon, a shorter period of intra-uterine balloon tamponade and early deflation of the balloon are recommended.
Subject(s)
Placenta Previa/therapy , Postpartum Hemorrhage/therapy , Uterine Balloon Tamponade , Adult , Area Under Curve , Blood Transfusion , Female , Humans , Hysterectomy , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/surgery , Pregnancy , ROC Curve , Retreatment , Retrospective Studies , Young AdultABSTRACT
OBJECTIVES: To evaluate iatrogenic urinary tract system injuries in obstetrics and gynecology operations and compare the results with the literature. PATIENTS AND METHODS: We examined the records of patients who had obstetric and gynecology operations at the Ministry of Health, Dr. Zekai Tahir Burak Women's Health, Training and Research Hospital between June 2007 and June 2010. All the patients who were diagnosed as having urinary system injuries in either the intraoperative or postoperative period were determined. RESULTS: During this period, 25,998 gynecologic and obstetrical operations were performed, 0.03% ureteric, 0.20% bladder, and one case of urethral injury, in a total of 0.24% urinary tract injuries were observed. The bladder was the most frequently injured organ. Total urinary tract injury rates were 0.79% (0.49% bladder, 0.24% ureteral) in gynecologic operations and 0.19% (0.18% bladder and 0.01% ureteral) in obstetric operations. CONCLUSION: Urinary system injuries are seen in approximately 1% of all gynecologic and obstetric surgeries. The complication rates observed in our patients were comparable with the other studies in the literature. A gynecologic surgeon must become familiar with the anatomy of the urinary tract and must be aware of common intraoperative and postoperative complications to decrease the risk of morbidity.
