Compression sutures for critical hemorrhage during cesarean section, 1st ed , satoru takeda, shintaro makino, 2020 1268

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Compression Sutures for Critical Hemorrhage During Cesarean Section A Guide by CG Animation Satoru Takeda Shintaro Makino Editors 123 Compression Sutures for Critical Hemorrhage During Cesarean Section Satoru Takeda • Shintaro Makino Editors Compression Sutures for Critical Hemorrhage During Cesarean Section A Guide by CG Animation Editors Satoru Takeda Department of Obstetrics and Gynecology Faculty of Medicine Juntendo University Bunkyo-ku Tokyo Japan Shintaro Makino Department of Obstetrics and Gynecology Faculty of Medicine Juntendo University Bunkyo-ku Tokyo Japan ISBN 978-981-32-9459-2    ISBN 978-981-32-9460-8 (eBook) https://doi.org/10.1007/978-981-32-9460-8 © Springer Nature Singapore Pte Ltd 2020 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Preface Although the maternal mortality rate is on a decreasing trajectory in Japan, 28–54 deaths (2006–2016) are still reported annually This number is equivalent to 2.8–5.0 deaths/100,000 live births This mortality rate is lower than those in other developed countries However, it has stopped decreasing and has instead remained constant for the past 10 years A redoubled effort is therefore necessary to achieve further improvement in perinatal outcomes According to a review of successful cases in which the pregnant woman was saved, 1  in approximately every 250 pregnant women requires critical care at the time of delivery and is exposed to life-­threatening events Among these, critical hemorrhage in obstetrics is the most common event, and massive hemorrhage during Cesarean section accounts for 70% of those suffering such an event Many of these urgent cases involve placenta previa accreta, hemorrhage from the placental separation site, concomitant disseminated intravascular coagulation (DIC), etc As the rate of Cesarean section has been rising in recent years, it is extremely important to master techniques for controlling hemorrhage during Cesarean section Efforts must still be made to reduce maternal mortality Thus, practice guide for treating critical hemorrhage in obstetrics has been developed, and efforts have been made to reduce the mortality rate of pregnant women In this circumstance, arterial ligation and stepwise uterine devascularization were conventionally performed as hemostatic techniques to control massive hemorrhage during Cesarean section without hysterectomy, thereby preserving the uterus However, depending on the sites of arterial ligation, the hemostatic effect was inadequate because of collateral circulation Subsequently, insufficient blood flow and ischemia in the preserved uterus caused complications, such as ovarian dysfunction and endometrial growth impairment Therefore, arterial ligation is no longer performed Because of the growing demands for optimal hemostatic techniques that preserve the uterus and its function, various compression sutures, including the B-Lynch suture which was first reported in 1997, are the current mainstream procedures for achieving hemostasis and have replaced arterial ligation These newer hemostatic techniques are now widely used in clinical practice Furthermore, there are recent reports describing hemostasis as having been achieved by intrauterine balloon tamponade alone or in combination with compression sutures Herein, compression sutures, which are surgical hemostatic techniques for critical hemorrhage during Cesarean section, are explained by using computer-­generated (CG) animation The limitations and problems encountered are also noted We hope v vi Preface that the thoughts of obstetricians with extensive experience treating critical hemorrhage in obstetrics can be read between the lines and that this book will help our readers to reduce maternal mortality, even if only modestly, in their future clinical practice Tokyo, Japan August 2018 Satoru Takeda Contents 1History of Surgical Remedies for Obstetrical Uterine Hemorrhage��������  1 Satoru Takeda and Yasuhisa Terao 2Uterine Compression Sutures for Atonic Bleeding ������������������������������������ 11 Shintaro Makino and Satoru Takeda 3Double Vertical Compression Sutures���������������������������������������������������������� 17 Shintaro Makino 4Vertical Compression Sutures with Contrivances�������������������������������������� 19 Jun Takeda 5Compression Sutures Removal �������������������������������������������������������������������� 23 Jun Takeda 6Critical Obstetrical Hemorrhage������������������������������������������������������������������ 27 Shigetaka Matsunaga and Satoru Takeda vii History of Surgical Remedies for Obstetrical Uterine Hemorrhage Satoru Takeda and Yasuhisa Terao Abstract Arterial ligation and stepwise uterine devascularization were formerly used as hemostatic techniques to control massive hemorrhage during cesarean section without hysterectomy and to preserve the uterus However, depending on the sites of arterial ligation, the hemostatic effect was often inadequate because of collateral circulation Subsequently, insufficient blood flow and ischemia in the preserved uterus caused ovarian dysfunction and endometrial growth impairment, (e.g., hypomenorrhea, oligomenorrhea, amenorrhea, and infertility) Furthermore, it has been recognized that subsequent pregnancies can be complicated by premature labor, spontaneous abortion, placenta accreta, etc At present, arterial ligation is not performed In place of this technique, various compression sutures, including the B-Lynch suture which was first reported in 1997, are the current mainstream hemostatic techniques for uterine hemorrhage during cesarean section and are widely used in clinical practice Moreover, Bakri et  al reported favorable hemostatic outcomes when managing hemorrhage from placenta previa and placenta previa accreta by balloon tamponade This technique is used for hemostasis in uterine hemorrhage not only during cesarean section but also after vaginal delivery The hemostatic techniques in use have recently undergone diversification, including application of a combination of intrauterine compression hemostasis and balloon tamponade and intraoperative arterial embolization, performed in a hybrid operating room S Takeda (*) · Y Terao Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan e-mail: stakeda@juntendo.ac.jp; yterao@juntendo.ac.jp © Springer Nature Singapore Pte Ltd 2020 S Takeda, S Makino (eds.), Compression Sutures for Critical Hemorrhage During Cesarean Section, https://doi.org/10.1007/978-981-32-9460-8_1 S Takeda and Y Terao Keywords Critical uterine hemorrhage · Cesarean section · Compression sutures · Uterine balloon tamponade · Interventional radiology · Arterial embolization · Arterial balloon occlusion · Damage control 1.1 Introduction In Japan, the main causes of maternal mortality include critical hemorrhage in obstetrics, cerebrovascular disease, amniotic fluid embolism, cardiac and macrovascular disease, pulmonary disease, and infection Among various causes of intrapartum critical hemorrhage, the most common is uterine hemorrhage associated with a coagulation disorder, followed by uterine rupture, atonic hemorrhage, premature separation, and uterine inversion In the past, uterine hemorrhage was conservatively treated by securing vascular access for fluid and blood product replacement, administration of uterotonics, and hemostatic techniques such as bimanual compression, uterine tamponade achieved by packing with gauze, uterine balloon tamponade, etc And also special care and appropriate treatment for concomitant disseminated intravascular coagulation should be needed in most cases with critical hemorrhage [1–4] When hemostasis was difficult to achieve despite these measures, laparotomy was performed for arterial ligation and hysterectomy However, arterial embolization has been used in recent years [5], allowing hemostasis without administering anesthesia or performing laparotomy, which further exacerbates the already poor general conditions of women suffering massive hemorrhage On the other hand, hemostatic techniques combined with uterine preservation that have been used during cesarean section in the past include arterial ligation (e.g., ligation of the internal iliac artery, uterine artery, and ascending branch of the uterine artery) and stepwise uterine devascularization, in which the feeding vessels around the uterus are sequentially ligated However, depending on the sites of arterial ligation, the hemostatic effect is often inadequate because of collateral circulation Even if the uterus is preserved, insufficient blood flow and uterine ischemia causes ovarian dysfunction and endometrial growth impairment, which can result in hypomenorrhea, oligomenorrhea, amenorrhea, and infertility It has also been reported that subsequent pregnancies are complicated by premature labor, spontaneous abortion, placenta accreta, etc Thus, novel hemostatic techniques that preserve the uterus and its function are eagerly awaited 1.2  hanges in Hemostatic Techniques for Uterine C Hemorrhage After Vaginal Delivery Intrauterine gauze packing and uterine balloon tamponade have been performed for postpartum uterine hemorrhage that is difficult to control [6] However, because these conservative treatment techniques have limits, surgical hemostasis 1  History of Surgical Remedies for Obstetrical Uterine Hemorrhage by arterial ligation at laparotomy was long performed as a hemostatic technique combined with uterine preservation Although ligation of the internal iliac artery was widely performed for more than 100 years, since the late 1800s, its hemostasis success was limited to the range of 40–60.7% This is mainly attributable to blood flow in the uterus substantially increasing during pregnancy and the uterus receiving blood flow from the external iliac, lumbar, median sacral, inferior mesenteric, and other arteries through abundant anastomoses at the periphery of the internal iliac artery Because of these anastomoses, ligation of the internal iliac artery does not reduce the blood flow in the uterine artery Thus, hemostasis cannot be achieved Particularly in cases with the placenta attached to the lower uterine segment, such as placenta previa and placenta previa accreta, the blood flow from the external iliac and other arteries further increases; consequently, ligation of the internal iliac artery becomes even less effective This situation prompted arterial ligation in the vicinity around the uterus Ligation of the uterine artery was reported by Waters in 1952 [7], and ligation of the ascending branch of the uterine artery was reported by O’Leary et al in 1966 [8] For uterine hemorrhage resistant to ligation of the uterine artery, AbdRabbo described, in 1994, a stepwise uterine devascularization process, in which the feeding vessels of the uterus were sequentially ligated [9] However, ligation of these arteries is performed via laparotomy and imposes a high risk on women whose general condition is poor due to massive hemorrhage At present, because catheterization procedures, such as arterial embolization, have been adopted, these surgical hemostatic techniques are very rarely performed 1.3 Hemostatic Techniques During Cesarean Section When hemostasis is performed for uterine hemorrhage during cesarean section, the abdomen is already open In this state, because hysterectomy can be performed in the worst case situations, surgical hemostatic techniques are also easy to perform [10] However, because massive hemorrhage is expected in cases, such as placenta previa accreta, placenta increta, and placenta percreta, hemostatic techniques have been attempted and studied under various conditions, taking into account general clinical states and factors (e.g., severity of hemorrhage, disease, and hemorrhagic tendency) and the presence or absence of fertility in various cases 1.3.1 Arterial Ligation Arterial ligation, including ligation of the internal iliac artery, has a limited hemostatic effect and is less effective in cases with abundant blood flow from the external iliac artery, such as placenta previa accreta [11] On the other hand, stepwise uterine devascularization, in which the feeding vessels of the uterus are sequentially ligated, has a relatively high hemostatic effect [9] However, even if the uterus is preserved, insufficient blood flow and uterine ischemia might cause ovarian dysfunction and .. .Compression Sutures for Critical Hemorrhage During Cesarean Section Satoru Takeda • Shintaro Makino Editors Compression Sutures for Critical Hemorrhage During Cesarean Section... Juntendo University Bunkyo-ku Tokyo Japan ISBN 97 8-9 8 1-3 2-9 45 9-2     ISBN 97 8-9 8 1-3 2-9 46 0-8  (eBook) https://doi.org/10.1007/97 8-9 8 1-3 2-9 46 0-8 © Springer Nature Singapore Pte Ltd 2020 This work is subject... Bunkyo-ku, Tokyo, Japan e-mail: shintaro@ juntendo.ac.jp © Springer Nature Singapore Pte Ltd 2020 S Takeda, S Makino (eds.), Compression Sutures for Critical Hemorrhage During Cesarean Section, https://doi.org/10.1007/97 8-9 8 1-3 2-9 46 0-8 _3
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