Download PDF
CC BY 4.0 · Surg J (N Y) 2021; 07(03): e216-e221
DOI: 10.1055/s-0041-1733990
Case Report

“Step-by-Step” Minimally Invasive Hemostatic Technique Using Intrauterine Double-Balloon Tamponade Combined with Uterine Isthmus Vertical Compression Suture for the Control of Placenta Accreta and Severe Atonic Hemorrhage during a Cesarean Section

Masaya Takahashi 
1   Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
,
Jun Takeda
1   Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
,
Sumie Haneda
1   Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
,
Sumire Ishii
1   Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
,
Mitsuko Shinohara
1   Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
,
Emiko Yoshida
1   Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
,
Anna Sato
1   Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
,
Shintaro Makino 
1   Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
,
Atsuo Itakura
1   Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

A sudden onset of postpartum hemorrhage (PPH) during a cesarean delivery requires urgent hemostasis procedures, such as the B-Lynch, Hayman, or double-vertical compression sutures, when bimanual compression, uterotonic agent administration, and intrauterine balloon tamponade had failed to achieve sufficient hemostasis. However, after invasive hemostatic procedures, postoperative complications, including subsequent synechiae and infection followed by ischemia, have been reported to occur even in successful cases. To avoid these complications, we devised and performed a minimally invasive combined technique based on a “step-by-step” minimally invasive hemostatic protocol for a case of placenta accreta and severe atonic hemorrhage during a cesarean delivery. A nullipara woman with a history of systemic lupus erythematosus and treatment with prednisolone and tacrolimus underwent a cesarean section because of a nonreassuring fetal status. Severe atonic hemorrhage and placenta accreta were observed which did not respond to bimanual compression and uterotonics. Because severe uterine atony and continuous bleeding from the placental attachment area were observed even with intrauterine balloon tamponade, vertical compression sutures were placed in the uterine isthmus. However, severe uterine atony and atonic bleeding from the uterine corpus persisted; thus, a second balloon was inserted into the uterine corpus. Hemostasis was accomplished with a combination of isthmus vertical compression sutures and double balloons which is a less-invasive approach than existing compression techniques. No complications related to these procedures were observed. This step-by-step minimally invasive hemostatic technique has the potential to control PPH with less complications, especially in immunocompromised patients.

Keywords

cesarean delivery - atonic hemorrhage - intrauterine double-balloon tamponade - vertical compression suture - minimally invasive hemostatic technique - surgical technique

Authors' Contributions

M.T., J.T., S.H., S.I., M.S., E.Y., and A.S. performed the experiments. J.T., S.M., and A.I. supervised the study. M.T. and J.T. prepared the manuscript.


Disclosure

None.




Publication History

Received: 23 November 2020

Accepted: 28 June 2021

Article published online:
26 August 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Takeda S, Takeda J, Makino S. A minimally invasive hemostatic strategy in obstetrics aiming to preserve uterine function and enhance the safety of subsequent pregnancies. Hypertens Res Pregnancy 2019; 7: 9-15
    CrossrefPubMedGoogle Scholar
  • 2 Revert M, Rozenberg P, Cottenet J, Quantin C. Intrauterine balloon tamponade for severe postpartum hemorrhage. Obstet Gynecol 2018; 131 (01) 143-149
    CrossrefPubMedGoogle Scholar
  • 3 B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. C BL. The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol 1997; 104 (03) 372-375
    CrossrefPubMedGoogle Scholar
  • 4 Ghezzi F, Cromi A, Uccella S, Raio L, Bolis P, Surbek D. The Hayman technique: a simple method to treat postpartum haemorrhage. BJOG 2007; 114 (03) 362-365
    CrossrefPubMedGoogle Scholar
  • 5 Makino S, Hirai C, Takeda J, Yorifuji T, Itakura A, Takeda S. Hemostatic technique during cesarean section. Hypertens Res Pregnancy 2016; 4: 6-10
    CrossrefPubMedGoogle Scholar
  • 6 Jung HN, Shin SW, Choi SJ. et al. Uterine artery embolization for emergent management of postpartum hemorrhage associated with placenta accreta. Acta Radiol 2011; 52 (06) 638-642
    CrossrefPubMedGoogle Scholar
  • 7 Yorifuji T, Takeda J, Makino S, Tanaka T, Itakura A, Takeda S. Evaluation of the effectiveness of metreurynters for balloon tamponade. Hypertens Res Pregnancy 2018; 6: 26-29
    CrossrefPubMedGoogle Scholar
  • 8 American College of Obstetricians and Gynecologists. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 2006; 108 (04) 1039-1047
    CrossrefPubMedGoogle Scholar
  • 9 Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage: green-top guideline no. 52. BJOG 2017; 124 (05) e106-e149
    CrossrefPubMedGoogle Scholar
  • 10 Tanaka T, Makino S, Yorifuji T. et al. Vertical compression sutures for control of postpartum hemorrhage from a placenta previa in cesarean section - to evaluate the usefulness of this technique. Hypertens Res Pregnancy 2014; 2: 21-25
    CrossrefPubMedGoogle Scholar
  • 11 Takeda J, Tanaka K, Ohashi R. Uterine isthmus vertical compression suture for controlling uterine corpus bleeding: a possible mechanism of decreasing uterine blood flow. Hypertens Res Pregnancy 2016; 4: 45
    CrossrefPubMedGoogle Scholar
  • 12 Makino S, Takeda J, Hirai C, Itakura A, Takeda S. Uterine balloon tamponade as a test to assess further treatment. Acta Obstet Gynecol Scand 2015; 94 (05) 556
    CrossrefPubMedGoogle Scholar
  • 13 Vasicka A, Kumaresan P, Han GS, Kumaresan M. Plasma oxytocin in initiation of labor. Am J Obstet Gynecol 1978; 130 (03) 263-273
    PubMedGoogle Scholar
  • 14 Georgiou C. Intraluminal pressure readings during the establishment of a positive ‘tamponade test’ in the management of postpartum haemorrhage. BJOG 2010; 117 (03) 295-303
    CrossrefPubMedGoogle Scholar
  • 15 Higashiyama N, Kondoh E, Ueda A. et al. ‘Tandem balloon tamponade’ for arterial bleeding from the uterine fundus: two case reports. J Obstet Gynaecol 2016; 36 (06) 769-771
    CrossrefPubMedGoogle Scholar
  • 16 Chakravarty EF, Bush TM, Manzi S, Clarke AE, Ward MM. Prevalence of adult systemic lupus erythematosus in California and Pennsylvania in 2000: estimates obtained using hospitalization data. Arthritis Rheum 2007; 56 (06) 2092-2094
    CrossrefPubMedGoogle Scholar
  • 17 Tomimatsu T, Hazama Y, Takeuchi M, Kimura T, Shimoya K. Unresponsiveness to oxytocin due to an extremely thin uterine wall in a pregnant woman with systemic lupus erythematosus and Sjögren's syndrome. J Obstet Gynaecol 2018; 38 (02) 276-278
    CrossrefPubMedGoogle Scholar
  • 18 Tokushige Y, Iwami S, Nonogaki T, Shibayama T, Shimada T, Minamiguchi S. Case report of a pregnant patient with systemic lupus erythematosus with uterine atony and very thin myometrium with uterine fibrosis. Int J Gynaecol Obstet 2017; 137 (02) 201-202
    CrossrefPubMedGoogle Scholar
  • 19 Mittal N, Pineda M, Lim B, Carey E. Placenta previa increta in an unscarred uterus with marked thinning of myometrium in the entire uterus in a patient with systemic lupus erythematosus. Int J Gynecol Pathol 2018; 37 (02) 198-203
    CrossrefPubMedGoogle Scholar
  • 20 Noh JJ, Park CH, Jo MH, Kwon JY. Rupture of an unscarred uterus in a woman with long-term steroid treatment for systemic lupus erythematosus. Obstet Gynecol 2013; 122 (2, pt. 2): 472-475
    CrossrefPubMedGoogle Scholar
  • 21 Colasanti T, Maselli A, Conti F. et al. Autoantibodies to estrogen receptor α interfere with T lymphocyte homeostasis and are associated with disease activity in systemic lupus erythematosus. Arthritis Rheum 2012; 64 (03) 778-787
    CrossrefPubMedGoogle Scholar
  • 22 Acconcia F, Totta P, Ogawa S. et al. Survival versus apoptotic 17beta-estradiol effect: role of ER alpha and ER beta activated non-genomic signaling. J Cell Physiol 2005; 203 (01) 193-201
    CrossrefPubMedGoogle Scholar
  • 23 Rabin DS, Johnson EO, Brandon DD, Liapi C, Chrousos GP. Glucocorticoids inhibit estradiol-mediated uterine growth: possible role of the uterine estradiol receptor. Biol Reprod 1990; 42 (01) 74-80
    CrossrefPubMedGoogle Scholar
  • 24 Ruiz-Arruza I, Ugarte A, Cabezas-Rodriguez I, Medina JA, Moran MA, Ruiz-Irastorza G. Glucocorticoids and irreversible damage in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2014; 53 (08) 1470-1476
    CrossrefPubMedGoogle Scholar
  • 25 Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis 1989; 11 (06) 954-963
    CrossrefPubMedGoogle Scholar
  • 26 Dixon WG, Abrahamowicz M, Beauchamp ME. et al. Immediate and delayed impact of oral glucocorticoid therapy on risk of serious infection in older patients with rheumatoid arthritis: a nested case-control analysis. Ann Rheum Dis 2012; 71 (07) 1128-1133
    CrossrefPubMedGoogle Scholar
  • 27 Hasegawa J, Ikeda T, Sekizawa A. et al; Maternal Death Exploratory Committee in Japan and the Japan Association of Obstetricians and Gynecologists. Recommendations for saving mothers' lives in Japan: report from the Maternal Death Exploratory Committee (2010-2014). J Obstet Gynaecol Res 2016; 42 (12) 1637-1643
    CrossrefPubMedGoogle Scholar
  • 28 Hasegawa J, Sekizawa A, Tanaka H. et al; Maternal Death Exploratory Committee in Japan, Japan Association of Obstetricians and Gynecologists. Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan. BMJ Open 2016; 6 (03) e010304
    CrossrefPubMedGoogle Scholar
  • 29 Gottlieb AG, Pandipati S, Davis KM, Gibbs RS. Uterine necrosis: a complication of uterine compression sutures. Obstet Gynecol 2008; 112 (2, pt. 2): 429-431
    CrossrefPubMedGoogle Scholar
  • 30 Mallappa Saroja CS, Nankani A, El-Hamamy E. Uterine compression sutures, an update: review of efficacy, safety and complications of B-Lynch suture and other uterine compression techniques for postpartum haemorrhage. Arch Gynecol Obstet 2010; 281 (04) 581-588
    CrossrefPubMedGoogle Scholar
  • 31 Sano Y, Takeda J, Kuroda K, Makino S, Itakura A, Takeda S. Embrittlement of uterus after uterine artery embolization: a case of uterine perforation. Hypertens Res Pregnancy 2016; 4: 42-44
    CrossrefPubMedGoogle Scholar
  • 32 Takeda J, Makino S, Ota A, Tawada T, Mitsuhashi N, Takeda S. Spontaneous uterine rupture at 32 weeks of gestation after previous uterine artery embolization. J Obstet Gynaecol Res 2014; 40 (01) 243-246
    CrossrefPubMedGoogle Scholar