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doi:10.1111/jog.12356
J. Obstet. Gynaecol. Res. Vol. 40, No. 5: 1249–1256, May 2014
Local injection of vasopressin reduces the blood loss during cesarean section in placenta previa Sosuke Kato, Akiko Tanabe, Kazuyoshi Kanki, Yusuke Suzuki, Takumi Sano, Kentaro Tanaka, Daisuke Fujita, Yoshito Terai, Hideki Kamegai and Masahide Ohmichi Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
Abstract Aim: The aim of this study was to evaluate the effect of local injection of vasopressin on blood loss and secondary impact on complications during cesarean section in patients with placenta previa. Material and Methods: We retrospectively reviewed the medical records of all patients diagnosed with placenta previa admitted to our hospital. Two consecutive periods were compared. During period B, 59 patients underwent the local injection of a vasopressin solution (4 U in 20 mL of saline) into the placental implantation site after placental delivery. During period A, 50 patients underwent cesarean section without vasopressin injection, and were analyzed as a control group. The estimated blood loss was recorded, as were the complications during surgery. In addition, the expression of the vasopressin V1α receptor in uterine smooth muscle was evaluated by immunohistochemistry. Results: The mean estimated blood loss was significantly lower in the vasopressin group than in the control group. There were no statistically significant differences with surgical complications. The vasopressin V1α receptor was highly expressed in smooth muscle cells in the lower segment of the uterine body, whereas the immunoreactivity for the oxytocin receptor was faint in the lower segment. Conclusion: The local injection of vasopressin into the placental implantation site significantly reduced the blood loss without increasing the morbidity. Key words: lower segment of uterine body, oxytocin receptor, placenta previa, vasopressin, vasopressin V1α receptor.
Introduction Placenta previa can have serious adverse consequences for the mother, including an increased risk of maternal mobility, antenatal and intrapartum hemorrhage,1 and the mother may therefore require a blood transfusion2 or even an emergency hysterectomy. Although it is a relatively rare condition with an overall incidence of 0.28–2.0% of all deliveries,3 it has been suggested that incidence of placenta previa is increasing.4 Cesarean delivery is necessary in practically all cases of placenta previa. The volume of hemorrhage during
surgery in cases of placenta previa is significantly higher than in cases of normal placental presentation, and the rate of blood transfusion is also significantly increased.5 Different traditional methods should be used to stop hemorrhaging, including sustained uterine massage, uterine packing, and uterotonic agents, such as oxytocin, ergometrine and prostaglandin. However, during cesarean section in patients with placenta previa, hemorrhage from the placental implantation site may continue after placenta delivery because the lower uterine segment has poorer contraction than the uterine body. Once profound uterine
Received: October 10 2013. Accepted: November 12 2013. Reprint request to: Dr Sosuke Kato, Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki-city, Osaka 569-8686, Japan. Email: [email protected]
© 2014 The Authors Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology
1249
S. Kato et al.
hemorrhaging occurs, then the uterine vasculature is less likely to respond to vasoconstrictor agents because of the potential absence of constrictor reactivity of the uterine vasculature as a result of an unknown mechanism.6 Therefore, resuscitative measures are often required with large-volume blood transfusion, and aggressive surgical intervention by hysterectomy is sometimes necessary to ensure survival. Many gynecological surgeons use a local injection of vasopressin, which is a known peripheral vasoconstrictor, at the time of laparoscopic myomectomy to decrease blood loss. In addition, the useful role for local infiltration of vasopressin to arrest hemorrhage from the placental bed has been demonstrated in several obstetrical case reports.7,8 The vasopressin V1α receptor (VP1αR) has been demonstrated to be present in the myometrium of both non-pregnant9 and pregnant women,10 and contributes to myometrial contraction.11 Therefore, we evaluated the effect of local injection of vasopressin on the blood loss and secondary impact on complications during cesarean section in cases of placenta previa. Furthermore, to evaluate the role of vasopressin as a constrictor of the myometrium, we examined the localization of VP1αR and oxytocin receptor (OTR) in pregnant uterine smooth muscle cells obtained from the lower segment of the uterine body by an immunohistochemical analysis.
Methods Patients All patients received treatment at the Department of Obstetrics and Gynecology of Osaka Medical College. This was a retrospective analysis approved by the Institutional Review Board of Osaka Medical College. Written informed consent was obtained from all patients participating in the study. From December 2000 through October 2012, 122 women were diagnosed with either partial or complete placenta previa, and their charts were reviewed for their medical and pregnancy history and their exposure to any potential risk factors. We included all women who delivered at our hospital after 22 weeks of gestation, whose age was between 18 and 40 years, and who had singleton pregnancies. The exclusion criteria included marginal placenta previa, percreta diagnosed prenatally, a known drug allergy to oxytocin or vasopressin, multiple gestation, significant obstetric disease (including pregnancy-induced hypertension or preeclampsia), known risk factors for postpartum hemor-
1250
rhage (including uterine fibroids and previous classical uterine incision), inherited or acquired coagulation disorders and thrombocytopenia. We diagnosed placenta increta and percreta according to the clinical or histologic criteria as follows:12 (i) manual removal of the placenta was partially or totally impossible, and there was no cleavage plane between part or all of the placenta and uterus during cesarean section; and (ii) there was histological confirmation on a hysterectomy specimen. We excluded any patients with placenta increta and percreta diagnosed at cesarean section from this study for evaluation of clinical outcome; however, three specimens from patients who had undergone a cesarean hysterectomy for placenta percreta, diagnosed preoperatively, were studied for following immunohistochemical analysis (Fig. 1). All enrolled patients received spinal anesthesia, followed by cesarean section. Spinal anesthesia was performed at the L3–4 interspace with hyperbaric bupivacaine (2.0 mL; 0.5%) with a 25 G needle by an anesthesiologist who was not involved in the study. During cesarean section, standard monitoring included electrocardiogram, blood pressure (BP), maternal heart rate (HR) and pulse oximetry. Intraoperative fluid management was performed at the discretion of the supervising anesthesiologist. We compared two periods: December 2000 to April 2006 (period A) and May 2006 to October 2012 (period B). As a routine protocol during both period A and period B, all patients received five units of i.v. oxytocin in 500 mL of a 5% glucose solution, and intramyometrial administration of five units oxytocin in 10 mL of 0.9% saline solution after removal of the placenta. During period B, patients received an additional i.m. injection of four units of vasopressin in 20 mL of saline into the placental implantation site after removal of the placenta (Fig. 2). The biological half-life of vasopressin has been pharmacologically calculated to be approximately 10–20 min.13 When massive bleeding started again after temporary hemostasis during the surgery, or when bleeding from the placental bed could not be controlled by injections of uterotonic agents, uterine tamponade or the use of parallel vertical compression sutures with 0-chromic14 were attempted immediately. When the bleeding could not be controlled by either tamponade or compression sutures, transcatheter arterial embolization (TAE) was performed. If such conservative methods failed, then hysterectomy was performed. There were no cases that developed re-bleeding after returning to the recovery room.
© 2014 The Authors Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology
Vasopressin injection in placenta previa
Figure 1 A flow chart of the study. CS, cesarean section.
vasopressin injection. The blood loss during cesarean section was estimated as follows: after incision of uterine muscle and rupture of membrane, amniotic fluid was collected as much as possible in the suction bottle. Blood loss was estimated by measuring the volume of blood collected in another suction bottle, and subtracting the amniotic fluid volume, with additions for weight changes of soaked linen savers, mops and pads. Hypotension was defined as a decrease in the mean BP by more than 10% of the baseline value. Tachycardia was defined as a maternal HR > 120 b.p.m.
Figure 2 Techniques used for infiltration procedures after removal of the placenta during cesarean section in cases of placenta previa.
Outcomes There were two outcomes: total estimated blood loss during cesarean section and major adverse effect of
Immunohistochemical analysis Three specimens from patients who had undergone a cesarean hysterectomy for placenta percreta diagnosed prenatally were studied. Tissue blocks were collected from the upper and lower segments (surrounding the internal os) of the uterine body. An immunohistochemical evaluation of the distribution of VP1αR, OTR and smooth muscle cells was performed. All blocks were fixed in buffered 10% paraformaldehyde solution and then embedded in paraffin. Some sections were stained with hematoxylin–eosin, whereas the other
© 2014 The Authors Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology
1251
S. Kato et al.
remaining sections were immunostained with a peptide-specific antibody against VP1αR (LS-A3831, MBL International), OTR (LS-A3878, MBL International), or a monoclonal antibody against smooth muscle actin (SMA) (M0851, DAKO). Negative control sections were processed by using non-specific immunoglobulin G (A0423, DAKO). The antigen-antibody complexes were identified using the Universal DAKO LSAB2-labeled streptavidin-biotin peroxidase kit (K0609, DAKO). Staining was detected using a Carl Zeiss (Gottingen, Germany) Axiophot microscope. Photographs were taken of different areas, and were further processed using Adobe Photoshop. Uterine smooth muscle cells and vascular smooth muscle cells in all lesions were evaluated for specific SMA staining. In the areas with strong SMA staining, the VP1αR and OTR immunohistochemical expression was quantified in accordance to the Allred score15 as follows. First, a proportion score was assigned, which represented the estimated proportion of positive-staining myometrial cells (0, none; 1, 1/100; 2, 1/100 to 1/10; 3, 1/10 to 1/3; 4, 1/3 to 2/3; and 5, >2/3). Next, an intensity score was assigned, which represented the average intensity of positive cells (0, none; 1, weak; 2, intermediate; and 3, strong). The proportion and intensity scores were then added to obtain a total score, which ranged from 0 to 8. The numerical scoring was confirmed by a second independent examination, where the investigator was blinded to the initial score. The scores obtained from three
different specimens and three different areas were calculated as the average ± standard deviation.
Statistical analyses The statistical calculations were performed using the jmp statistical software package (sas Institute). An anova was used for group comparisons. The values were compared using Wilcoxon’s test as a nonparametric test or the χ2-test to analyze differences between the values recorded in periods A and B. The scores of cell staining were analyzed according to nonparametric Wilcoxon’s tests. A P-value < 0.05 was considered to be statistically significant.
Results Table 1 summarizes the characteristics of the study population. The groups did not differ significantly in the maternal age, parity, history of abortion, history of uterine surgeries, history of cesarean section, weeks of gestation at delivery, weight of the infant and the placental insertion.
Additional injection of vasopressin in the placental implantation site reduced the total blood loss in patients with placenta previa Table 2 describes the outcomes for all patients during periods A and B. The mean total estimated blood loss in the control and vasopressin groups was 1633.8 mL and
Table 1 Maternal characteristics in placenta previa cases according to the period
Maternal age (years) Parity (n) 0 ≥1 Previous abortion (n) Previous uterine surgery (n) Uterine repair Myomectomy Previous cesarean section (n) 1 ≥2 Weeks of gestation Weight of infant (g) Placental insertion (n) Partial placenta previa Complete placenta previa
Period A Control group (n = 50)
Period B Vasopressin group (n = 59)
P
32.2 ± 4.4
33.8 ± 5.1
NS
24 (48%) 26 (52%) 18 (36%)
32 (54%) 27 (46%) 21 (36%)
NS NS NS
0 (0%) 3 (6%) 6 (12%) 5 (10%) 1 (2%) 35.5 ± 2.8 2503 ± 501
0 (0%) 2 (3%) 5 (8%) 4 (7%) 1 (2%) 34.8 ± 3.0 2257 ± 582
NS NS NS NS NS NS NS
10 (20%) 40 (80%)
18 (31%) 41 (69%)
NS NS
NS, not significant.
1252
© 2014 The Authors Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology
Vasopressin injection in placenta previa
Table 2 Comparison of surgical data between the control and vasopressin groups
Total estimated blood loss (mL) Blood loss > 2000 mL (n) Total operating room time (min) Transfer to ICU (n) Duration of stay in ICU (days) Disseminated intravascular coagulation Postpartum sepsis (n) Interventions after CS (n) Uterine tamponade Compression procedures TAE Hysterectomy Adverse effect during CS (n) BP elevation >140/90 mmHg Pulse decrease by 15 b.p.m. Oliguria
Period A Control group (n = 50)
Period B Vasopressin group (n = 59)
P
1633.8 ± 843.0 13 (26%) 75 ± 33 3 (6%) 1.3 ± 0.6 3 (6%) 0 (0%)
1149.2 ± 522.6 4 (7%) 76 ± 16 2 (3%) 1.5 ± 0.7 2 (3%) 0 (0%)
doi:10.1111/jog.12356
J. Obstet. Gynaecol. Res. Vol. 40, No. 5: 1249–1256, May 2014
Local injection of vasopressin reduces the blood loss during cesarean section in placenta previa Sosuke Kato, Akiko Tanabe, Kazuyoshi Kanki, Yusuke Suzuki, Takumi Sano, Kentaro Tanaka, Daisuke Fujita, Yoshito Terai, Hideki Kamegai and Masahide Ohmichi Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
Abstract Aim: The aim of this study was to evaluate the effect of local injection of vasopressin on blood loss and secondary impact on complications during cesarean section in patients with placenta previa. Material and Methods: We retrospectively reviewed the medical records of all patients diagnosed with placenta previa admitted to our hospital. Two consecutive periods were compared. During period B, 59 patients underwent the local injection of a vasopressin solution (4 U in 20 mL of saline) into the placental implantation site after placental delivery. During period A, 50 patients underwent cesarean section without vasopressin injection, and were analyzed as a control group. The estimated blood loss was recorded, as were the complications during surgery. In addition, the expression of the vasopressin V1α receptor in uterine smooth muscle was evaluated by immunohistochemistry. Results: The mean estimated blood loss was significantly lower in the vasopressin group than in the control group. There were no statistically significant differences with surgical complications. The vasopressin V1α receptor was highly expressed in smooth muscle cells in the lower segment of the uterine body, whereas the immunoreactivity for the oxytocin receptor was faint in the lower segment. Conclusion: The local injection of vasopressin into the placental implantation site significantly reduced the blood loss without increasing the morbidity. Key words: lower segment of uterine body, oxytocin receptor, placenta previa, vasopressin, vasopressin V1α receptor.
Introduction Placenta previa can have serious adverse consequences for the mother, including an increased risk of maternal mobility, antenatal and intrapartum hemorrhage,1 and the mother may therefore require a blood transfusion2 or even an emergency hysterectomy. Although it is a relatively rare condition with an overall incidence of 0.28–2.0% of all deliveries,3 it has been suggested that incidence of placenta previa is increasing.4 Cesarean delivery is necessary in practically all cases of placenta previa. The volume of hemorrhage during
surgery in cases of placenta previa is significantly higher than in cases of normal placental presentation, and the rate of blood transfusion is also significantly increased.5 Different traditional methods should be used to stop hemorrhaging, including sustained uterine massage, uterine packing, and uterotonic agents, such as oxytocin, ergometrine and prostaglandin. However, during cesarean section in patients with placenta previa, hemorrhage from the placental implantation site may continue after placenta delivery because the lower uterine segment has poorer contraction than the uterine body. Once profound uterine
Received: October 10 2013. Accepted: November 12 2013. Reprint request to: Dr Sosuke Kato, Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki-city, Osaka 569-8686, Japan. Email: [email protected]
© 2014 The Authors Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology
1249
S. Kato et al.
hemorrhaging occurs, then the uterine vasculature is less likely to respond to vasoconstrictor agents because of the potential absence of constrictor reactivity of the uterine vasculature as a result of an unknown mechanism.6 Therefore, resuscitative measures are often required with large-volume blood transfusion, and aggressive surgical intervention by hysterectomy is sometimes necessary to ensure survival. Many gynecological surgeons use a local injection of vasopressin, which is a known peripheral vasoconstrictor, at the time of laparoscopic myomectomy to decrease blood loss. In addition, the useful role for local infiltration of vasopressin to arrest hemorrhage from the placental bed has been demonstrated in several obstetrical case reports.7,8 The vasopressin V1α receptor (VP1αR) has been demonstrated to be present in the myometrium of both non-pregnant9 and pregnant women,10 and contributes to myometrial contraction.11 Therefore, we evaluated the effect of local injection of vasopressin on the blood loss and secondary impact on complications during cesarean section in cases of placenta previa. Furthermore, to evaluate the role of vasopressin as a constrictor of the myometrium, we examined the localization of VP1αR and oxytocin receptor (OTR) in pregnant uterine smooth muscle cells obtained from the lower segment of the uterine body by an immunohistochemical analysis.
Methods Patients All patients received treatment at the Department of Obstetrics and Gynecology of Osaka Medical College. This was a retrospective analysis approved by the Institutional Review Board of Osaka Medical College. Written informed consent was obtained from all patients participating in the study. From December 2000 through October 2012, 122 women were diagnosed with either partial or complete placenta previa, and their charts were reviewed for their medical and pregnancy history and their exposure to any potential risk factors. We included all women who delivered at our hospital after 22 weeks of gestation, whose age was between 18 and 40 years, and who had singleton pregnancies. The exclusion criteria included marginal placenta previa, percreta diagnosed prenatally, a known drug allergy to oxytocin or vasopressin, multiple gestation, significant obstetric disease (including pregnancy-induced hypertension or preeclampsia), known risk factors for postpartum hemor-
1250
rhage (including uterine fibroids and previous classical uterine incision), inherited or acquired coagulation disorders and thrombocytopenia. We diagnosed placenta increta and percreta according to the clinical or histologic criteria as follows:12 (i) manual removal of the placenta was partially or totally impossible, and there was no cleavage plane between part or all of the placenta and uterus during cesarean section; and (ii) there was histological confirmation on a hysterectomy specimen. We excluded any patients with placenta increta and percreta diagnosed at cesarean section from this study for evaluation of clinical outcome; however, three specimens from patients who had undergone a cesarean hysterectomy for placenta percreta, diagnosed preoperatively, were studied for following immunohistochemical analysis (Fig. 1). All enrolled patients received spinal anesthesia, followed by cesarean section. Spinal anesthesia was performed at the L3–4 interspace with hyperbaric bupivacaine (2.0 mL; 0.5%) with a 25 G needle by an anesthesiologist who was not involved in the study. During cesarean section, standard monitoring included electrocardiogram, blood pressure (BP), maternal heart rate (HR) and pulse oximetry. Intraoperative fluid management was performed at the discretion of the supervising anesthesiologist. We compared two periods: December 2000 to April 2006 (period A) and May 2006 to October 2012 (period B). As a routine protocol during both period A and period B, all patients received five units of i.v. oxytocin in 500 mL of a 5% glucose solution, and intramyometrial administration of five units oxytocin in 10 mL of 0.9% saline solution after removal of the placenta. During period B, patients received an additional i.m. injection of four units of vasopressin in 20 mL of saline into the placental implantation site after removal of the placenta (Fig. 2). The biological half-life of vasopressin has been pharmacologically calculated to be approximately 10–20 min.13 When massive bleeding started again after temporary hemostasis during the surgery, or when bleeding from the placental bed could not be controlled by injections of uterotonic agents, uterine tamponade or the use of parallel vertical compression sutures with 0-chromic14 were attempted immediately. When the bleeding could not be controlled by either tamponade or compression sutures, transcatheter arterial embolization (TAE) was performed. If such conservative methods failed, then hysterectomy was performed. There were no cases that developed re-bleeding after returning to the recovery room.
© 2014 The Authors Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology
Vasopressin injection in placenta previa
Figure 1 A flow chart of the study. CS, cesarean section.
vasopressin injection. The blood loss during cesarean section was estimated as follows: after incision of uterine muscle and rupture of membrane, amniotic fluid was collected as much as possible in the suction bottle. Blood loss was estimated by measuring the volume of blood collected in another suction bottle, and subtracting the amniotic fluid volume, with additions for weight changes of soaked linen savers, mops and pads. Hypotension was defined as a decrease in the mean BP by more than 10% of the baseline value. Tachycardia was defined as a maternal HR > 120 b.p.m.
Figure 2 Techniques used for infiltration procedures after removal of the placenta during cesarean section in cases of placenta previa.
Outcomes There were two outcomes: total estimated blood loss during cesarean section and major adverse effect of
Immunohistochemical analysis Three specimens from patients who had undergone a cesarean hysterectomy for placenta percreta diagnosed prenatally were studied. Tissue blocks were collected from the upper and lower segments (surrounding the internal os) of the uterine body. An immunohistochemical evaluation of the distribution of VP1αR, OTR and smooth muscle cells was performed. All blocks were fixed in buffered 10% paraformaldehyde solution and then embedded in paraffin. Some sections were stained with hematoxylin–eosin, whereas the other
© 2014 The Authors Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology
1251
S. Kato et al.
remaining sections were immunostained with a peptide-specific antibody against VP1αR (LS-A3831, MBL International), OTR (LS-A3878, MBL International), or a monoclonal antibody against smooth muscle actin (SMA) (M0851, DAKO). Negative control sections were processed by using non-specific immunoglobulin G (A0423, DAKO). The antigen-antibody complexes were identified using the Universal DAKO LSAB2-labeled streptavidin-biotin peroxidase kit (K0609, DAKO). Staining was detected using a Carl Zeiss (Gottingen, Germany) Axiophot microscope. Photographs were taken of different areas, and were further processed using Adobe Photoshop. Uterine smooth muscle cells and vascular smooth muscle cells in all lesions were evaluated for specific SMA staining. In the areas with strong SMA staining, the VP1αR and OTR immunohistochemical expression was quantified in accordance to the Allred score15 as follows. First, a proportion score was assigned, which represented the estimated proportion of positive-staining myometrial cells (0, none; 1, 1/100; 2, 1/100 to 1/10; 3, 1/10 to 1/3; 4, 1/3 to 2/3; and 5, >2/3). Next, an intensity score was assigned, which represented the average intensity of positive cells (0, none; 1, weak; 2, intermediate; and 3, strong). The proportion and intensity scores were then added to obtain a total score, which ranged from 0 to 8. The numerical scoring was confirmed by a second independent examination, where the investigator was blinded to the initial score. The scores obtained from three
different specimens and three different areas were calculated as the average ± standard deviation.
Statistical analyses The statistical calculations were performed using the jmp statistical software package (sas Institute). An anova was used for group comparisons. The values were compared using Wilcoxon’s test as a nonparametric test or the χ2-test to analyze differences between the values recorded in periods A and B. The scores of cell staining were analyzed according to nonparametric Wilcoxon’s tests. A P-value < 0.05 was considered to be statistically significant.
Results Table 1 summarizes the characteristics of the study population. The groups did not differ significantly in the maternal age, parity, history of abortion, history of uterine surgeries, history of cesarean section, weeks of gestation at delivery, weight of the infant and the placental insertion.
Additional injection of vasopressin in the placental implantation site reduced the total blood loss in patients with placenta previa Table 2 describes the outcomes for all patients during periods A and B. The mean total estimated blood loss in the control and vasopressin groups was 1633.8 mL and
Table 1 Maternal characteristics in placenta previa cases according to the period
Maternal age (years) Parity (n) 0 ≥1 Previous abortion (n) Previous uterine surgery (n) Uterine repair Myomectomy Previous cesarean section (n) 1 ≥2 Weeks of gestation Weight of infant (g) Placental insertion (n) Partial placenta previa Complete placenta previa
Period A Control group (n = 50)
Period B Vasopressin group (n = 59)
P
32.2 ± 4.4
33.8 ± 5.1
NS
24 (48%) 26 (52%) 18 (36%)
32 (54%) 27 (46%) 21 (36%)
NS NS NS
0 (0%) 3 (6%) 6 (12%) 5 (10%) 1 (2%) 35.5 ± 2.8 2503 ± 501
0 (0%) 2 (3%) 5 (8%) 4 (7%) 1 (2%) 34.8 ± 3.0 2257 ± 582
NS NS NS NS NS NS NS
10 (20%) 40 (80%)
18 (31%) 41 (69%)
NS NS
NS, not significant.
1252
© 2014 The Authors Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology
Vasopressin injection in placenta previa
Table 2 Comparison of surgical data between the control and vasopressin groups
Total estimated blood loss (mL) Blood loss > 2000 mL (n) Total operating room time (min) Transfer to ICU (n) Duration of stay in ICU (days) Disseminated intravascular coagulation Postpartum sepsis (n) Interventions after CS (n) Uterine tamponade Compression procedures TAE Hysterectomy Adverse effect during CS (n) BP elevation >140/90 mmHg Pulse decrease by 15 b.p.m. Oliguria
Period A Control group (n = 50)
Period B Vasopressin group (n = 59)
P
1633.8 ± 843.0 13 (26%) 75 ± 33 3 (6%) 1.3 ± 0.6 3 (6%) 0 (0%)
1149.2 ± 522.6 4 (7%) 76 ± 16 2 (3%) 1.5 ± 0.7 2 (3%) 0 (0%)
