• Techniques: Bakri Insertion, Compression Sutures

    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…

  • Management: Approach after Vaginal Delivery

    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…

  • 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)​ Definition Complicated Placental Locations are defined as placental locations that add additional challenge to Caesarean section by…

  • 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…

  • 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)…

  • 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…

  • 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…

  • ECV Summary & References

    Summary All women with a breech pregnancy at or near term should be offered an ECV if there are no contraindications.​ Average success rate approximately 49-58% with lower rates in nulliparous women.​ Early ECV increases the likelihood of cephalic presentation at birth with no decrease in c-section rate or increase in preterm…

  • Alternatives to ECV

    Postural Management for Breech Presentation Postures included pelvic elevation in a knee-chest position, and supine head down position with pelvis elevated with a wedge-shaped cushion​ ​Conclusion: No evidence that postural management is effective in facilitating spontaneous version.​ Moxibustion for Breech Presentation Moxibustion (burning an herb close to the skin) at the BL67 acupuncture…

  • Standard Protocol for Performing an ECV

    Pre-Procedure Hospital setting with immediate access to perform an emergency cesarean delivery ​ Ultrasound prior to the procedure to confirm:​ Non-vertex presentation​ Normal amniotic fluid ​ Exclusion of fetal anomalies​ Placental location​ External fetal monitoring to assess fetal heart rate and contractions​ Non-stress test or biophysical profile prior to the procedure​ Informed…