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PICC Lines in Pregnancy and Other Peripartum Vascular Access Considerations.
Obstet Gynecol Surv
January 2025
Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC.
Importance: To decrease associated infectious and thrombotic morbidity, it is important to understand the indications and risks of peripherally inserted central catheters (PICCs) and other vascular access means in pregnancy.
Objectives: The objectives are 3-fold: (1) discuss indications and contraindications, approach to placement, and associated complications for PICC lines, arterial catheters, centrally inserted central catheters, and peripheral intravenous catheters; (2) review available data regarding complications associated with these catheters in pregnancy; and (3) propose an evidence-based approach to clinical decision making regarding vascular access in 2 clinical scenarios among pregnant patients.
Evidence Acquisition: A literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines, with a focus on obstetrical anesthesia and obstetric literature.
Effectiveness of the Triple P Procedure and its modifications on reducing the blood loss and peripartum hysterectomy rates in women with Placenta Accreta Spectrum (PAS): a review of published literature.
J Matern Fetal Neonatal Med
December 2025
Director of Global Academy of Medical Education & Training, London, UK.
Background: Placenta Accreta Spectrum (PAS) disorders has been reported to be associated with a maternal mortality rate of 7-10%, worldwide, and many women who survive, experience life changing morbidity. Triple P procedure (- perioperative placental localization and incision on the myometrium above the upper border of the placenta; - pelvic devascularisation; and -placental non-separation and myometrial excision) was developed in 2010 as a novel conservative alternative to peripartum hysterectomy to avoid severe maternal morbidity and mortality). There have been several modifications to the original Triple P Procedure to achieve "pelvic devascularisation" based on locally available resources.
View Article and Find Full Text PDFPlacental Adhesion Subsequent to Uterine Preservation via Resuscitative Endovascular Balloon Occlusion of the Aorta: A Case Report.
Cureus
December 2024
Department of Obstetrics and Gynecology Faculty of Medicine, Fukuoka University, Fukuoka, JPN.
An adherent placenta is a life-threatening condition that impairs the mother's life owing to hemorrhagic shock and disseminated intravascular coagulation. Profound hemorrhage resulting from placental abruption is often managed using hysterectomy to preserve the mother's life, although the consequent loss of fertility can be devastating, particularly in younger women. Thus, strategies that facilitate fertility preservation while effectively controlling hemorrhage should be considered viable alternatives.
View Article and Find Full Text PDFSignificance of Diagnostic Findings of Placenta Percreta by Magnetic Resonance Imaging and Pathological Correlation.
Cureus
December 2024
Radiology Department, Hospital Regional Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Monterrey, Universidad de Monterrey, Monterrey, MEX.
Placenta percreta is a rare form of disorder found in the spectrum of placenta accreta and represents a considerable cause of maternal complications with an increase in mortality. The radiologist's role is essential due to the support of images acquired by magnetic resonance imaging, given their high sensitivity and specificity to predict the degree of placental invasion in substitution or accompaniment of the ultrasound study between 28 and 32 weeks of gestation. We present the case of a 29-year-old patient who was in her third pregnancy with a history of two cesarean sections at the ISSSTE Regional Hospital in Monterrey, Nuevo León.
View Article and Find Full Text PDFDevelopment and validation of a prognostic nomogram for severe postpartum hemorrhage after cesarean delivery: A two-center retrospective study.
Int J Gynaecol Obstet
January 2025
Department of Obstetrics and Gynecology, The First Affiliate Hospital of Jinan University, Jinan University, Guangzhou, China.
Objectives: To develop and validate a nomogram to predict severe postpartum hemorrhage following cesarean delivery.
Methods: This is a two-center retrospective cohort study. Cesarean delivery patients from the First Affiliate Hospital of Jinan University were divided into a development cohort (n = 11 137) and an internal validation cohort (n = 4739).
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