• 5.1.8 Interventional/Surgical Management of PPH

    Bakri Balloon Indications for Bakri Balloon See section on clinical decision-making. Insertion of a Bakri Balloon for Uterine Tamponade​ Ensure adequate analgesia/anesthesia-transfer to OR​ Ensure uterus is empty (consider manual exploration or gentle curettage if retained POC is a possibility).​ Insert vaginal speculum (or use one hand in the vagina) and grasp…

  • 5.1.4 Approach to Management of PPH

    Successful treatment of PPH requires rapid response to bleeding and continual planning of the next step to be taken if the current measures are not enough.  It also depends on excellent communication amongst the team with a willingness to ask for help early in the process.  The approach is not…

  • 4.2.0 Complicated Placental Locations

    Cesarean Sections with Complicated Placental Locations Module by: Nicole Wade and Katherine Rabicki Learning Objectives Define complicated placental locations​ Identification on antenatal ultrasound​ Preparing for and managing:​ Anterior placenta​ Low-lying placenta​ Placenta previa​ Placenta accreta​ Placenta with a succenturiate lobe (maybe)​ Topics 4.2.1 Background Information 4.2.2 Antenatal Identification of Placental Location…

  • 4.2.6 References

    Cunningham F, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY. Williams Obstetrics, 25e; 2018. Available at: https://accessmedicine.mhmedical.com/ViewLarge.aspx?figid=185084128&gbosContainerID=0&gbosid=0&groupID=0&sectionId=185083809&multimediaId=undefined Hobson SR, Kingdom JC, Murji A, Windrim RC, Carvalho JCA, Singh SS, Ziegler C, Birch C, Frecker E, Lim K, Cargill Y, Allen LM. No. 383-Screening, Diagnosis, and Management…

  • 4.2.5 Placenta Accreta Syndromes

    Morbidly Adherent Placentas Accreta: villi are attached to the myometrium Increta: villi invade the myometrium Percreta: penetrate through the myometrium and to/through the serosa Risk Factors Similar risk factors for placenta previa Associated placenta previa Prior cesarean delivery Prior endometrial curettage or ablation (myometrial damage) Elevated human chorionic gonadotropin (hCG)…

  • 4.2.3 Anterior Placenta

    General Surgical Considerations Fetal delivery should be fast as there is a theoretical risk of fetal bleeding​ A low transverse hysterotomy can theoretically cause fetal bleeding if the placenta is implanted anteriorly, however a classical incision or high transverse can increase maternal bleeding and morbidity in subsequent pregnancies. ​ Practically, a lower segment hysterotomy…

  • 4.2.2 Antenatal Identification of Placental Location

    Sonography Ideally sonography is used for antepartum identification of placental location​ Timing: Diagnosis of placenta previa or low-lying placenta should NOT be made <18 to 20 weeks GA, and provisional dx should be confirmed >32 weeks GA, or sooner if clinically warranted (SOGC Guideline 402).​ Method: Assessment by transvaginal ultrasound is recommended in all…

  • 4.2.1 Background Information

    Definition Complicated Placental Locations are defined as placental locations that add additional challenge to Caesarean section by way of increasing morbidity and mortality risk, often by way of severe hemorrhage.​ Disclaimer Some patients with complicated placental locations (i.e. placenta accreta spectrum) are best served at tertiary care centres able to provide specialized care. This module is not…

  • 4.2.4 Low-lying Placenta and Placenta Previa

    Low-Lying Placenta Definition The placental edge does not cover the cervical os but lies ≤ 20mm from the os. ​ Placenta Previa Definition The internal cervical os is covered partially or completely by the placenta.​ Risk Factors for Placenta Previa Maternal age  (>35 years of age)​ Multiparity​ Cigarette smoking​ Uterine leiomyomas ​ Prior cesarean deliveries​ Elevated maternal serum…

  • 2.1.8 References

    Cluver  C, Gyte  GML, Sinclair  M, Dowswell  T, Hofmeyr  GJ. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD000184. DOI: 10.1002/14651858.CD000184.pub4. Accessed 04 April 2021.​ Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane…