Treatment decision-making for post-partum hemorrhage using dynamic contrast-enhanced computed tomography.

AIM: Post-partum hemorrhage (PPH) is the leading cause of maternal mortality. Identification of the precise bleeding site is generally important to control hemorrhage, but such an approach has not been fully established in the context of PPH. We postulated that visualization of bleeding sites could aid treatment decisions in the management of PPH. METHODS: We conducted a prospective review of 26 patients who underwent dynamic computed tomography (CT) for PPH. RESULTS: A total of 17 cases presented with uterine bleeding, eight with vaginal hematomas, and one with hemoperitoneum. Overall, dynamic CT identified contrast media extravasation in the arterial phase in 12 of 26 (46.2%) cases: the upper (n = 4) and the lower uterine segment including the cervix (n = 2), subfascial space (n = 1) and vagina (n = 5). Identification of precise arterial bleeding sites using CT provided informative guidance about where to place balloons for intractable uterine bleeding, and how to manage hemoperitoneum and vaginal hematomas. In addition, dynamic CT revealed the existence of a subtype of uterine atony, which is characterized by focal active arterial bleeding in the upper uterine segment. Furthermore, negative contrast extravasation extracted cases of PPH that were well controlled without the need for surgical or radiological intervention. No patient required emergency hysterectomy to control PPH. CONCLUSION: Dynamic CT has potential clinical utility in treatment decision-making for PPH.

Cervical clamp with ring forceps to prevent prolapse of an intrauterine balloon in the management of postpartum hemorrhage.

An intrauterine balloon tamponade is a simple but highly effective method for the management of postpartum hemorrhage. However, treatment failure can occur due to prolapse of an intrauterine balloon into the vagina. We present two cases with a successful maneuver in maintaining the intrauterine placement of the balloon by clamping the cervix with two ring forceps in the management of postpartum hemorrhage. Although the balloon was initially expelled through a dilated cervix, a cervical clamp using ring forceps prevented displacement of the balloon, and the hemorrhage ceased. Clamping the cervix with two ring forceps to retain the balloon can be a simple and readily available approach to consider when an intrauterine balloon tamponade does not work due to its expulsion.

Oncofertility care in young women and the outcomes of pregnancy over the last 5 years.

AIM: To ascertain the actual outcomes of oncofertility care in young women to provide more appropriate care. MATERIALS & METHODS: We analyzed the data of 67 female patients under 43 years of age who underwent oncofertility care between January 2015 and September 2019. RESULTS: There were 28 patients with breast cancer, 19 patients with hematologic cancer and 20 patients with other cancer diagnoses. Breast cancer patients tended to take longer than hematologic cancer patients to initiate oncofertility treatment. Despite undergoing oncofertility care, seven of nine pregnant patients did not choose assisted reproductive technology (ART). CONCLUSION: As spontaneous pregnancies were more common than ART pregnancies in our study, pregnancy by not only ART but also non-ART method is a viable option for young cancer survivors.

Expression and intracellular distribution of the G protein-coupled receptor 30 in rat hippocampal formation.

Although the expression and distribution of nuclear estrogen receptors in the hippocampus has been described, it has been proposed that the nuclear receptors may not explain all aspects of estrogen function in the hippocampus. Recently, a G protein-coupled receptor for estrogen, GPR30, was identified as a membrane-localized estrogen receptor in several cancer cell lines. In this study, we examined the expression and intracellular distribution of GPR30 in the rat hippocampal formation. We found expression of GPR30 in pyramidal cells of CA1-3 and granule cells of the dentate gyrus at both mRNA and protein levels. Specific markers for intracellular organelles and immunoelectron microscopy revealed that GPR30 was mainly localized to the Golgi apparatus and partially in the endoplasmic reticulum of the neuron but could not detect the protein at the cell surface. Expression levels were not different among male, female in proestrus and female in estrus at the adult stage, but were higher in newborn male than newborn female.

Successful management of intraoperative hemorrhage from placenta previa accreta: intrauterine tamponade balloons brought out through the abdominal wall.

BACKGROUND: Conservative management for placenta previa accreta (PPA) may be preferred, but uncontrollable hemorrhage sometimes occurs during a cesarean section. CASE: We present a case with a successful maneuver for the management of intraoperative hemorrhage in PPA. Profuse hemorrhage occurred due to partial placental separation during a cesarean section. The bleeding was stopped by the placement of intrauterine tamponade balloons with their shafts passed through the anterior abdominal wall. The catheters were removed after 24 h. The patient had no complications, and the placenta spontaneously resorbed three months after delivery. CONCLUSION: This is a useful addition to the options for management of PPA at cesarean section.