Efficacy of various surgical techniques for controlling bleeding from placental bed in cases of placenta previa

Abstract

Introduction: Placenta previa is one of the leading causes of severe postpartum hemorrhage. When coinciding with placenta accreta, it may be associated with life-threatening maternal hemorrhage after removal of the placenta due to its incomplete separation and massive bleeding from the placental attachment site. To study the efficacy of conservative surgical techniques like Cho square compression sutures and Stepwise uterine devascularization in controlling the bleeding from placental bed in cases of placenta previa. Material and Methods: This is a Prospective and Observational study carried out in the Department of Obstetrics and Gynaecology from April 2017 to March 2018 at Narayana Medical College, Nellore. 100 pregnant women who were diagnosed to have placenta previa were taken into the study. Placenta previa diagnosed on USG undergoing abdominal delivery and who had placental bed bleed during surgery, irrespective of their gestational age and parity were included. Abruptio placenta and medical comorbidities like pre-eclampsia, coagulation disorders were excluded. Estimated blood loss was assessed roughly by weighing of laparotomy pads before and after soiling and amount in suction apparatus. In all cases, foetal outcome was observed in form of maturity, birth weight and perinatal morbidity and mortality. Results: The mean age of women with PP in the present study is 26±2.7 years. The highest incidence of placenta previa is in the age group of 25-29 years i.e. 51 cases (51%) while the least incidence was in the age group of 35-39 years i.e. 0 cases. Incidences in the age groups 20-24 years and 30-34 years are 38 cases (38%) and 11 cases (11%) respectively. The most common presentation of women with placenta previa is antepartum haemorrhage. 52 women (52%) presented with bleeding per vaginum at the time of admission and 48(48%) presented with no complaints of bleeding per vaginum. Though placenta previa is more commonly seen in multigravidas, it is not so uncommon in primigravidas, with 11% of primigravidas in the study having placenta previa. The incidence of placenta previa was highest in women with third pregnancy accounting to 44 cases (44%), followed by second pregnancy (36 cases). Conclusion: In order to decrease the morbidity rate and to prevent the adverse effects of hysterectomy,
conservative surgical techniques like Cho Square compression sutures and Stepwise Uterine Devascularization are effective in controlling placental bed bleed in 97% and 89% of cases and can be considered as first step measures to control postpartum haemorrhage in cases of Placenta Previa.