The cervix as a natural tamponade in postpartum hemorrhage caused by placenta
previa and placenta previa accreta: a prospective study
#MMPMID26559634
El Gelany SA
; Abdelraheim AR
; Mohammed MM
; Gad El-Rab MT
; Yousef AM
; Ibrahim EM
; Khalifa EM
BMC Pregnancy Childbirth
2015[Nov]; 15
(?): 295
PMID26559634
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BACKGROUND: Placenta previa and placenta accreta carry significant maternal and
fetal morbidity and mortality. Several techniques have been described in the
literature for controlling massive bleeding associated with placenta previa
cesarean sections. The objective of this study was to evaluate the efficacy and
safety of the use of the cervix as a natural tamponade in controlling postpartum
hemorrhage caused by placenta previa and placenta previa accreta. METHODS: This
prospective study was conducted on 40 pregnant women admitted to our hospital
between June 2012 and November 2014. All participating women had one or more
previous cesarean deliveries and were diagnosed with placenta previa and/or
placenta previa accreta. Significant bleeding from the placental bed during
cesarean section was managed by inverting the cervix into the uterine cavity and
suturing the anterior and/or the posterior cervical lips into the anterior and/or
posterior walls of the lower uterine segment. RESULTS: The technique of cervical
inversion described above was successful in stopping the bleeding in 38 out of 40
patients; yielding a success rate of 95%. We resorted to hysterectomy in only two
cases (5%). The mean intra-operative blood loss was 1572.5 mL, and the mean
number of blood units transfused was 3.1. The mean time needed to perform the
technique was 5.4?±?0.6 min. The complications encountered were as follows:
bladder injury in the two patients who underwent hysterectomy and wound infection
in one patient. Postoperative fever that responded to antibiotics occurred in 1
patient. The mean duration of the postoperative hospital stay was 3.5 days
CONCLUSIONS: This technique of using the cervix as a natural tamponade appears to
be safe, simple, time-saving and potentially effective method for controlling the
severe postpartum hemorrhage (PPH) caused by placenta previa/placenta previa
accreta. This technique deserves to be one of the tools in the hands of
obstetricians who face the life-threatening hemorrhage of placenta accreta. TRIAL
REGISTRATION: ClinicalTrials.gov NCT02590484 . Registered 28 October 2015.
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