The bladder was reflected downward to adequately expose the underlying lower uterine segment before making the uterine incision. (1) Cesarean section (CS) with a median incision was performed in the usual manner. The surgical procedure for VCS is described below. These 2 groups were compared about intraoperative blood loss and the rate of patients with intraoperative blood loss > 2,000 ml. 77 patients after VCS were introduced were divided into 63 in whom VCS were not used and 14 who received VCS. The investigated parameters were clinical characteristics of the patients (maternal age, parity, weeks of gestation, newborn weight, and primary placental location), intraoperative blood loss and the rate of patients with intraoperative blood loss > 2,000 ml, and the rate who required a hysterectomy. Among the latter group, VCS were employed in 14 cases. 38 patients were treated before the introduction of VCS and 77 patients were treated after its introduction. We tried to control bleeding by methods other than hysterectomy in all case because we avoid surgical complications due to emergency hysterectomy. In this period, there are 115 patients with placenta previa. Patients in whom placenta accreta had been highly suspected prior to surgery were excluded. The study group comprised patients treated in our hospital for placenta previa from January 2001 through December 2012. It is a retrospective study based on hospital records. In this study, we evaluated the effectiveness of VCS to control massive bleeding due to placenta previa. As we consider VCS to be a first-line treatment for bleeding when the usual methods are not effective, we have been using the original or modified hemostatic technique for placenta previa to control bleeding from the separated surface since September 2007. Before August 2007, we used intrauterine gauze packing, internal iliac artery ligation or hysterectomy if hemostasis could not be achieved by the usual methods, such as the administration of oxytocic drugs, bimanual compression of the lower uterine segment, or direct sutures applied to the separated surface. The advantages of VCS are that the time required for suturing is extremely short and the procedure itself is simple. 10) reported their use of vertical compression sutures (VCS) as a method of controlling hemorrhage from the separated surface of the lower uterine segment in cases of placenta previa or placenta accreta. Various methods to reduce this massive hemorrhage have been suggested, such as intrauterine gauze packing, 1) interrupted sutures, 1) stepwise uterine vessel ligation, 2) internal iliac artery ligation, 3) original or modified B-Lynch sutures, 4, 5) transcatheter arterial embolization (TAE), 6) use of Bakri balloon tamponade, 7, 8) and hysterectomy. Moreover, many of these women develop disseminated intravascular coagulation (DIC) shortly after this massive hemorrhage, which makes hemostasis even more difficult. The rate of patients with hemorrhage > 2,000 ml was 37% (14/38) before VCS were introduced and 19% (15/77) after their introduction ( P 2,000 ml was 13% (8/63) in the Non-VCS group and 50% (7/14) in the VCS Group ( P<0.05).Ĭonclusions: VCS is effective for controlling bleeding with a placenta previa.Īfter placental removal, massive hemorrhage commonly occurs in women with a placenta previa. Results: The average blood loss during surgery was 1,910☑,536 ml before the introduction of VCS and 1,530☖99.0 ml after its introduction. The 77 patients were divided into 2 groups, 63 women in whom VCS were not used (Non-VCS Group) and 14 women who received VCS (VCS Group) the groups were compared. Methods: We analyzed 115 patents with placenta previa and compared 38 patients before the introduction of VCS and 77 patients after its introduction. The aim of this study is to evaluate the usefulness of vertical compression sutures (VCS) for controlling bleeding in patients with a placenta previa. Aim: Various methods to reduce postpartum hemorrhage due to placenta previa have been suggested.
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