pituitrin and Postpartum-Hemorrhage

To investigate the effect of subendometrial vasopressin injection in patients with abnormally invasive placenta (AIP), who underwent cesarean section and hysterectomy.. This randomized double-blinded clinical trial was conducted on pregnant women diagnosed with AIP grade 4 and 5 by ultrasonography during cesarean section. Women were randomly divided into two equal groups including group 1 (vasopressin) and group 2 (control) who underwent 20 units of vasopressin and 20 cc normal saline injection, respectively. Vasopressin and placebo were injected subendometrially 1 cm medial to the uterine vessels into the lower uterine segment. The exclusion criteria include presence of myocardial infarction, cardiomyopathy, congestive heart failure, uncontrolled hypertension, chronic obstructive pulmonary disease, pelvic malignancy. The outcome of the study was total quantitative blood loss during the cesarean section. We estimated blood loss by measuring the blood volume in one of the suction bottles with addition for weight changes of mops, pads, and soaked linen savers.. Sixty patients were recruited into the study, 30 as the vasopressin group and 30 as the controls; with no excluded case. The amount of bleeding in the vasopressin group was significantly lower compared with that in the control group (P < 0.001). In the vasopressin group, 83.4% of patients had bleeding of less than 1.5 L, while only 3.3% of the control women had bleeding of less than 1.5 L (relative risk = 5). In addition, the number of injected packed cells was lower in the vasopressin group (P < 0.001).. It was shown that vasopressin injection can help prevent excess hemorrhage and the subsequent risks of anemia or blood transfusions during abdominal hysterectomy in women with AIP.

Topics: Adult; Blood Transfusion; Cesarean Section; Double-Blind Method; Female; Humans; Hysterectomy; Placenta; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Vasopressins

Two women, one with refractory postabortion hemorrhage and the other with refractory postpartum hemorrhage, were managed with vasopressin, operative hysteroscopy, and a dilute vasopressin pack. Both patients had been treated by standard methods (i.e., dilation and curettage) and both were being prepared for a surgical intervention procedure. It was decided in both cases to try to slow the bleeding by injection of vasopressin paracervically and then performance of operative hysteroscopy. In both cases, the injection of dilute vasopressin paracervically when coupled with operative hysteroscopy was quite effective in determining the cause of the bleeding and was instrumental in avoiding major operative procedures.. Obstetrician-gynecologists from the University of California at Davis have managed uterine bleeding in 2 cases using vasopressin and hysteroscopy. The postabortion case began hemorrhaging 4 days after suction curettage at 13 weeks gestation. At the hospital, she received packed blood cells and underwent dilation and curettage (D&C). After 3 days of bed rest at home, she began rehemorrhaging. In the emergency room, she again underwent a transfusion. They prepared her for a laparotomy and either hypogastric artery ligation or hysterectomy. Before surgery, however, they opted to inject vasopressin around the cervix and to use a resectoscope to determine the cause of bleeding. The bleeding diminished after injection of vasopressin. They observed arterial bleeding. They used an electrode set at 100 W to coagulate bleeding points, then packed the uterus with gauze soaked in dilute vasopressin solution. They removed the pack 18 hours later. After 2 hours bed rest with no additional bleeding, she became ambulatory. Since no additional bleeding occurred, she was discharged. After 8 months, she continued to experience normal menses. The postpartum case began to bleed profusely 21 days after a cesarean section. Physicians handled her case similarly to the postabortion case. They tried a hysteroscopy, but being unable to see due to heavy bleeding they injected vasopressin paracervically. The blood flow decreased substantially within a few minutes allowing them to use a resectoscope. Placental tissue and amniotic membranes were still present in the uterus and removed. Using the same procedures of the postabortion case, they coagulated the bleeding points and packed the uterus with gauze. She did not experience any significant bleeding for 24 hours so she was discharged. Normal menses resumed and, as of 4 months after discharge, she was fine.

Topics: Abortion, Induced; Adult; Female; Humans; Hysteroscopy; Postpartum Hemorrhage; Pregnancy; Uterine Hemorrhage; Vasopressins

Topics: Female; Humans; Labor Stage, Third; Oxytocin; Postpartum Hemorrhage; Pregnancy; Vasopressins

Topics: Adult; Cesarean Section; Female; Hemostatics; Humans; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Vasopressins

Topics: Adult; Female; Humans; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Vasopressins

Topics: Adult; Female; Humans; Iliac Artery; Infusions, Parenteral; Postpartum Hemorrhage; Pregnancy; Radiography; Vasopressins

Topics: Adult; Angiography; Arteries; Female; Humans; Infusions, Intra-Arterial; Ligation; Postoperative Complications; Postpartum Hemorrhage; Pregnancy; Vasopressins

Topics: Adult; Age Factors; Animals; Behavior, Animal; Diabetes Insipidus; Female; Headache; Humans; Hypertonic Solutions; Hypopituitarism; Hypothalamo-Hypophyseal System; Kidney; Necrosis; Osmolar Concentration; Oxytocin; Parity; Postpartum Hemorrhage; Pregnancy; Puerperal Disorders; Vasopressins; Water-Electrolyte Balance

Topics: Biomedical Research; Ergonovine; Female; Humans; Labor, Induced; Labor, Obstetric; Muscle Contraction; Oxytocin; Pharmacology; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Sparteine; Toxicology; Uterus; Vasopressins

Topics: Diabetes Insipidus; Estradiol; Female; Humans; Hypopituitarism; Postpartum Hemorrhage; Postpartum Period; Prednisolone; Pregnancy; Testosterone; Thyroid Gland; Tissue Extracts; Vasopressins