Prophylactic occlusion balloons of both internal iliac arteries in caesarean hysterectomy for placenta accreta spectrum disorder reduces blood loss: A retrospective comparative study.

Background: The placenta accreta spectrum is a complex disorder characterized by abnormal invasion of the placenta into the uterine wall, posing a significant risk of life-threatening haemorrhage for patients. Its incidence is on the rise, largely attributed to the increasing rates of caesarean sections. Management of this spectrum involves a multidisciplinary approach, although standardized protocols are not yet established. While caesarean hysterectomy remains the standard Gold, several adjunctive treatments have emerged in recent years to mitigate bleeding risk and associated morbidity. Among these, prophylactic occlusion balloons placed in the internal iliac arteries have shown promise. The aim of our study is to demonstrate the effect of prophylactic occlusion balloons in both uterine iliac arteries in the management of placental accreta spectrum disorders. Methods: A retrospective monocentric cohort study was conducted in the Department "C" of Gynaecology and Obstetrics at the Maternity Center of Tunis. The study spanned three years, from January 2nd, 2020, to December 31st, 2022. The study population consisted of two groups: Control Group (CG) comprised patients who underwent caesarean hysterectomy without internal-iliac prophylactic occlusion balloons, and Occlusion balloons of both internal iliac arteries Group (OBIIAG) included patients who underwent caesarean hysterectomy with internal-iliac prophylactic occlusion balloons. Results: A total of 38 patients were included in the study, all of whom exhibited similar epidemiological characteristics and comparable personal and obstetric histories. The most prevalent risk factor among the patients was a history of caesarean section (92%). On average, patients were diagnosed at 30 weeks of gestation, with third-trimester bleeding being the most common presentation (71% of cases). The median gestational age at delivery was between 36 and 37 weeks. We observed a significant difference in blood loss between the two groups (2888 ml in the control group and 1828 ml in the group with internal-iliac prophylactic occlusion balloons, p < 0.05). Implementation of this technique resulted in a reduced need for massive transfusions (p < 0.01) and shorter operating times (126 min for the control group and 92 min for the group with internal-iliac prophylactic occlusion balloons; p = 0.04). There were no significant differences in morbidity between the two groups. Conclusion: The intra-iliac prophylactic occlusion balloons can help reduce the risk of hemorrhage and the morbidities that come with the placenta accreta spectrum disorder.

Tourniquet on the low segment of the uterus reduces blood loss in postpartum hemorrhage during hysterectomy for placenta accreta: Old but gold.

Objectives: To investigate the feasibility, safety, and efficiency after application of a cervical tourniquet during caesarian hysterectomy owing to placenta accreta. Study design: It was a monocentric prospective observational study for 3 years. Patients were allocated into two group: Group Tourniquet: (TG) in which a cervical tourniquet was systematically applied during hysterectomy, control group (CG) when the caesarian hysterectomy was performed without. Results: 20 patients in the TG and 23 patients in the CG. Tourniquet application significantly reduced per operative estimated blood loss volume (TG: 530 ± 135 vs 940 ± 120 ml in the CG, p = 0.0074), ΔHB (0.6 [0.3-1.9] vs 2.5[2.5-3.6] g/dl in the CG, p = 0.006) RBC transfusion requirements' (TG: 2 ± 1.7 vs 4.3 ± 2.1 units in the CG, p = 0.046) procedure duration (TG: 98 ± 21 vs 137 ± 33 min in the CG, p = 0.015), clotting disorders (TG: 1 (5%) vs 6 (26,1%) in the CG, p = 0.013) and the incidence of bladder wounds (TG: 1 (5%) vs 5 (21,7%) in the CG, p = 0.048). There was no significant difference regarding ICU transfer rate (TG: 16 (80%) vs 20 (86.9%) in the CG, p = 0.53) or length of stay (TG: 1.4 [2,3] vs 2.3 [1-4] days in the CG, p = 0.615) and digestive wound (TG: 0 vs 2 (8,7%) in the CG, p = 0.641). Conclusion: In case of a radical management of placenta accreta. A strategy that involves the application of a cervical Tourniquet should be considered as a feasible, safe and above all efficient alternative to prevent blood spoliation.

Prognostic value of highly-sensitive troponin in preeclampsia.

INTRODUCTION: Pre-eclampsia is a pregnancy complication leading to significant morbidity and mortality. High-sensitivity troponin (hs-cTnI ) is one of the most sensitive cardiac biomarkers, but its variation in preeclampsia remains poorly studied. AIM: To assess the prognostic value of hyper-sensitive troponin in preeclampsia. METHODS: It was a prospective study including patients with preeclampsia. The exclusion criteria included conditions that may cause an elevation of hs-cTnI. Preoperative laboratory assessment included the determination of the level of hs-cTnI. The discriminative value of the preoperative hs-cTnI allowing to predict the onset of complications was evaluated by the ROC curve. Group A included patients whose rate was above the calculated cutoff, and group B included the others. RESULTS: Seventy seven patients were included. Complications occurred in 22% of cases. The preoperative hs-cTnI cutoff of 6.3 ng/l predicted the onset of complications (sensitivity 70.6% / specificity 86.6% / p < 0.0001). There was a higher rate of severe pre-eclampsia and complications, a higher systolic and mean arterial blood pressure values in group A with significant differences. Both groups were comparable demographically, obstetrically, clinically and biologically. CONCLUSION: According to the results of our study, increased values of preoperative hs-cTnI may predict the onset of complications in pregnancies complicated by preeclampsia.

[Safety of Magnesium sulfate in severe preeclampsia]. / Sulfate de Magnésium au cours de la Préeclampsie Sévère : Innocuité d'utilisation ?

BACKGROUND: Several observational studies and randomized trials have described the use of various regimens of magnesium sulfate to prevent or reduce the rate of seizures and complications in women with severe preeclampsia. AIM: To assess the validity of a service protocol in the management of severe pre-eclampsia all specifying the benefits, complications and side effects of magnesium sulfate . METHODS: We have performed a retrospective descriptive study over two years (2009-2010) concerning 150 patients affected with severe preeclampsia in the department "B" of gynecology and obstetrics of the "Rabta" at the Centre of Maternity and Neonatology of Tunis (third level maternity). The protocol consisted in the administration of 3 grammes of magnesium sulfate followed by intravenous dose of 1 g/hour associated with an anti-hypertensive treatment. RESULTS: One hundred and forty patients (93%) had 2 or more criteria of severity associated. Seventy-eight (52 %) patients with severe preeclampsia have profited an anti-hypertensive treatment based on nicardipine associated with magnesium sulfate without notable secondary effects. In two cases (1.3 %) an eclampsia was noted with magnesium sulfate, 27.4 % of severe preeclampsia was noted at a term within 34 week of amenorrhea. Only one case of surdosage was noted in post partum. CONCLUSION: The use of magnesium sulfate in practice does not appear to increase the risk of complications or major side effects in the mother and fetus.

[Haemorrhage delivery. About 65 cases]. / Hémorragie de la délivrance: etude rétrospective a propos de 65 cas.

The delivery haemorrhage is actually a problem of public health. It is responsible of 31.5 % of the maternal death in Tunisia. The goal of this work is to study the frequency of this complication, its gravity, its risk factors, its etiologists and its methods of treatment. It is a retrospective study. of 65 cases of delivery haemorrhage recorded to the obstetric gynaecology service "C" of the centre of motherhood and neonatology of Tunis during 4 years. The frequency of the delivery haemorrhage in our study is 1.19%. The middle age of the patient is of 31 years. Their middle parity is 2.4. Factors of risk taking out again our set are: gestational toxemia (35.4%), primiparity (33.8%), advanced maternal age (30.7%), pre-existent anaemia (24.6%). the uterine surdistension (21.3%), an abnormal middle length of labour (69.6%). use of oxytocin during labour (34%), induction (21.5%). Etiologists in our set are: atone in 63% of cases, retained placenta in 31.2% des cases, coagulopathie (9.2%), placenta previa (1.5%), uterine inversion (1.5%). The hold must be in charge multidisciplinary, systematized, precocious and dynamic.

[Management of ectopic pregnancy. about 77 cases]. / Prise en charge de la grossesse extra-utérine. A propos de 77 cas.

We report a retrospective study of 77 ectopic pregnancies, collected over a period of 5 years and 4 months. The aim of this study was to analyse the epidemiology, the clinical and special investigation findings of this pathology, and to report our result as regards management of ectopic pregnancy, eectopic pregnancy affects young women (mean age : 31.8 years), whether multiparous or pauciparous (81.1%). The most important risk factors were endouterine maneuvres (42.8 %) and IUD (36.3%). Suspicion of the diagnosis was based on clinics findings, US examination and beta HCG dosage. Diagnostic coelioscopy was performed in 90 % of cases to confirm the diagnosis. 7 patient underwent immediate laparotomie. Ectopic pregnancy was ampullar in 80% of cases. Treatment was given through a coelioscopy in 44 cases (57%). A laparo-conversion was required in 26 patient (33.7%). Treatment was radical in 52% of cases. We didn't note any serious per-operative or post-operative complication. About eighteen percent (18.1%) of out patient who subsequently wanted to get pregnatn, got an intra-uterine pregnancy. Only one case of recurrence was noted in our series.

[Maternal benefit of postpartum corticosteroid therapy in patients with HELLP (hemolysis elevated liver enzymes low platelets count) syndrome]. / Intérêt de la corticothérapie en post partum dans le HELLP (hemolysis elevated liver enzymes low platelets count) syndrome.

Our purpose was to assess the effects of corticotherapy prescribed after delivery on the kinetic of biological parameters of HELLP syndrome (hemolysis elevated liver enzymes low platelets count). Twenty patients in whom pregnancy was complicated by antepartum or postpartum Hellp Syndrome, were randomised to receive, after delivery, either 12 mg of Dexamethasone every 12 hours for two doses (Group C, n=10), or a placebo (Group T, n=10). Biological parameters of the Hellp syndrome were analysed just before the first bolus of either treatment (H0), then after 24, 36, 48 and 72 hours. The corticotherapy was more efficient than placebo, in the correction of the biological parameters of the hellp syndrome. It permitted a rapid correction of the thrombopenia (from the 24th hour) but its effect on hemolysis marker was later (from the 36th hour). The kinetic of the hepatic cytolysis marker was not modified by corticotherapy. Finally, the administration of corticosteroids does not reduce maternal morbidity related to HELLP Syndrome.

[Uterine rupture: report of 41 cases]. / Ruptures uterines: a propos de 41 cas.

To establish the epidemiological profile, of patients who presented a uterine rupture, as well as the obstetrical follow up, the neonatal outcome and the prognosis factors. A retrospective study of 41 cases of uterine rupture treated in the maternity center of Tunis during a 5-year period. The frequency of uterine rupture was 1.38%@1000 of births. Rupture in scarred uterus was found in 58.5% of the cases against 41.5% in sain uterus. Three risk factors were statistically significant in our series: cesarian section, multiparity and high fetal weight. Uterine rupture is a medico-surgical emergency causing materno-fetal morbidity and mortality.