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In this episode, episode 55, I welcome back frequent guest of the show Dr. Mike Hofkamp to pick up where I left off last time with Dr. Jacqueline Galvan as we discuss problems that can occur with pregnancy at term (part 2) including complications of labor and delivery.
CME: https://earnc.me/u60sBT
Outline by Brian Park: Outline
Didn’t finish the podcast yet, but I have a comment and a question.
Comment: Regarding uterine rupture in TOLAC’s. I think it’s important that everyone involved understands exactly what is meant by “prior cesarean.” There are some women who have had prior classical cesareans, where a vertical uterine incision is made. I’m far from an expert, but now-a-days I think this is usually done in cases of ceaseans done at an early gestational age, before the lower uterine segment has had time to develop. This kind of incision is more likely to rupture during labor than your now-standard low transverse c-section, which is done in the lower uterine segment. Wioman with prior classical cesareans cannot TOLAC. I’m sure most OB’s are going to know exactly what procedures a patient has had previously, but it’s something good for us to know about too.
Question: Do you know anything about using retrograde endovascular balloon occlusion of the aorta (REBOA) as a temporizing measure during severe post-partum hemorrhage? It’s used frequently in trauma, even pre-hospital in parts of Europe. But I only found one Norwegian study looking at its use in obstetrics. Seems like it could be a great way to control bleeding while the patient is prepared for possible uterine artery embolization or hysterectomy. Maybe it could even decrease the need for hysterectomy.
Thanks!
Hi Shaun,
Great comment, you are absolutely right.
I passed your question on to Dr. Hofkamp and here is his reply:
When I attend national meetings, I have seen case reports where endovascular balloons are placed peoperatively in the interventional radiology suite prior to anticipated combined cesarean section/hysterectomies. This is still an evolving area of knowledge. In my practice of providing anesthesia for planned cesarean section/hysterectomies, I do not recall any patients who had such endovascular balloons placed. I think there needs to be more data about this technique.