Bakri Balloon Indications for Bakri Balloon See section on clinical decision-making. Insertion of a Bakri Balloon for Uterine Tamponade Ensure adequate analgesia/anesthesia-transfer to OR Ensure uterus is empty (consider manual exploration or gentle curettage if retained POC is a possibility). Insert vaginal speculum (or use one hand in the vagina) and grasp…
Indications for medical management of PPH Early/suspected PPH: EBL>500ml with on-going bleeding Ongoing bleeding despite early management with simple measures (See 5.1.5) If bleeding continues despite simple measures, a cascade of directed interventions is begun. Medical therapy is instituted, taking into account the availability of i.v. access and also contraindications related to…
EBL <500 with on-going bleeding after vaginal delivery Deliver placenta and administer oxytocin 5-10 IU (I.M. or I.V.) Massage uterus, continuous bimanual compression Check for lacerations Check placenta for completeness Review patient history (prolonged labour? Previous uterine surgery?) Where is the rest of the team? (nursing, anesthesia, obstetrics, surgeon, blood bank, transport…
Successful treatment of PPH requires rapid response to bleeding and continual planning of the next step to be taken if the current measures are not enough. It also depends on excellent communication amongst the team with a willingness to ask for help early in the process. The approach is not…
Module by: Nicole Wade and Katherine Rabicki Learning Objectives Define complicated placental locations Identification on antenatal ultrasound Preparing for and managing: Anterior placenta Low-lying placenta Placenta previa Placenta accreta Placenta with a succenturiate lobe (maybe) Definition Complicated Placental Locations are defined as placental locations that add additional challenge to Caesarean section by…
Cunningham F, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY. Williams Obstetrics, 25e; 2018. Available at: https://accessmedicine.mhmedical.com/ViewLarge.aspx?figid=185084128&gbosContainerID=0&gbosid=0&groupID=0§ionId=185083809&multimediaId=undefined Hobson SR, Kingdom JC, Murji A, Windrim RC, Carvalho JCA, Singh SS, Ziegler C, Birch C, Frecker E, Lim K, Cargill Y, Allen LM. No. 383-Screening, Diagnosis, and Management…
Morbidly Adherent Placentas Accreta: villi are attached to the myometrium Increta: villi invade the myometrium Percreta: penetrate through the myometrium and to/through the serosa Risk Factors Similar risk factors for placenta previa Associated placenta previa Prior cesarean delivery Prior endometrial curettage or ablation (myometrial damage) Elevated human chorionic gonadotropin (hCG)…
General Surgical Considerations Fetal delivery should be fast as there is a theoretical risk of fetal bleeding A low transverse hysterotomy can theoretically cause fetal bleeding if the placenta is implanted anteriorly, however a classical incision or high transverse can increase maternal bleeding and morbidity in subsequent pregnancies. Practically, a lower segment hysterotomy…
Low-Lying Placenta Definition The placental edge does not cover the cervical os but lies ≤ 20mm from the os. Placenta Previa Definition The internal cervical os is covered partially or completely by the placenta. Risk Factors for Placenta Previa Maternal age (>35 years of age) Multiparity Cigarette smoking Uterine leiomyomas Prior cesarean deliveries Elevated maternal serum…
Summary All women with a breech pregnancy at or near term should be offered an ECV if there are no contraindications. Average success rate approximately 49-58% with lower rates in nulliparous women. Early ECV increases the likelihood of cephalic presentation at birth with no decrease in c-section rate or increase in preterm…