A Participant-assigned Interventional Research of Precesarean Internal Iliac Artery Balloon Catheterization for Managing Intraoperative Hemorrhage of Placenta Previa and Placenta Accreta Spectrum Disorders After Cesarean Section

Placenta accreta spectrum disorder (PASD) and placenta previa (PP) are two of the mosthideous obstetric complications which are usually associated with a history of cesarean section(CS). Moreover, women with PASD, PP and/or a cesarean scarred uterus are more likely to haveadverse pregnancy outcomes, including blood transfusion, hysterectomy, pelvic organs damage,postpartum hemorhage, disseminated intravascular coagulation, multi-organ dysfunction syndromeand even maternal or fetal death. This study aimed to investigate the efficacy of precesareaninternal iliac artery balloon catheterization (BC) for managing severe hemorhage caused by PASDand PP with a history of CS. This participant-assigned interventional study was conducted inTongji Hospital. We recruited 128 women with suspected PASD, PP and a history of CS. Womenin the BC group accepted precesarean BC of bilateral internal iliac arteries before the scheduledcesarean delivery. Women in the control group underwent a conventional cesarean delivery.Intraoperative hemorrhage, transfusion volume, radiation dose, exposure time, complicationsand neonatal outcomes were discussed. There were significant differences in calculated bloodloss (CBL) between BC group and control group (1015.0±144.9 vs. 1467.0±171.0 mL, P=0.04).Precesarean BC could reduce intraoperative red blood cell (RBC) transfusion as compared withcontrol group (799.5±136.1 vs. 1286.0±161.6 mL, P=0.02) and lessen the rate of using bloodproducts (57.1% vs. 76.4%, P=0.02). The incidence of hysterectomy was also lower in BC groupthan in control group. Postpartum outcomes showed no significant differences between the twogroups, except that postoperation hospitalization was longer in BC group than in control group(6.7±0.4 vs. 5.8±0.2 days, P=0.03). Precesarean BC of internal iliac artery is an effective methodfor managing severe hemorrhage caused by PASD and PP with a cesarean scarred uterus, as it couldreduce intraoperative blood loss, lessen intraoperative RBC transfusions and potentially decreasehysterectomies.

Labor Induction with Oral Misoprostol in Term Pregnancy: A Clinical Trial

Introduction: Induction of labor has become an increasingly utilized obstetric intervention in developed countries. It contributes to reduce the maternal and perinatal morbidity and mortality. Dinoprostone derivatives are often used under cardiotocography. In poor countries, health structures have neither fetal monitoring, nor means of preserving Dinoprostone derivatives. Misoprostol therefore constitutes an alternative. This study seeks to establish the efficacy and safety of oral Misoprostol and to assess maternal and perinatal prognosis in an area with limited resource. Methods: This is a multi-center clinical trial, conducted in 3 hospitals centers in Kisangani, Tshopo Province/Democratic Republic of Congo from December 1, 2020 to May 31, 2021. Our sample was constituted with 68 pregnant women with term pregnancy. Fifty micrograms of Misoprostol was administered orally. The data were collected prospectively, their encoding was carried out on an Excel sheet 2013 and their analysis carried out using the EPI INFO software. Results: The average age of the pregnant women was 23.17 ± 5.76 years. The average parity was 1.02 ± 1.2. The average body mass index (BMI) was 24.98 ± 2.55 Kg/m2. 66 (97.1%) patients had received a maximum of 3 doses of Misoprostol. Out of the 16 parturients who received 3 doses or more, 11 (68.8%) had a BMI ≥ 25. The average duration of labor was 16.03 ± 7.99 hours. 66 (97.1%) pregnant women had delivered vaginally. 57 (83.8%) patients delivered within 24 hours. Out of the 11 patients who delivered after 24 hours, 7 (63.6%) had a BMI ≥ 25. The induction failure rate was 2.9% (2 patients). 2 (2.9%) fetuses had presented pathological modification of fetal heart rate (FHR). 2 (2.9%) patients had undergone cesarean section. Conclusion: Labor induction with oral Misoprostol is effective and associated with low maternal and perinatal morbidity. A BMI ≥ 25 kg/m2 increases the number of doses to be given and the duration of labor.