Factors Contributing to Massive Blood Loss on Peripartum Hysterectomy for Abnormally Invasive Placenta: Who Bleeds More?

Table 4

Process of blood loss in patients with emergent AIP-hysterectomy.

Case	Para	History of CS	Obstetric complication	Total blood loss (mL)	Blood loss until manual placental removal (mL)	Decision time for hysterectomy from start of CS (min)	Hemostatic procedure	Blood loss from placental removal to start of hysterectomy (mL)	Blood loss during hysterectomy (mL)
13	1	Present	Leiomyoma	5,550	1,295	26	Manual compression, gauze packing	920	3,335
14	1	Present	Leiomyoma	7,830	3,205	35	Manual compression, gauze packing	827	3,798
15	0	Absent		12,010	2,790	32	HC	2,100	7,120
16	0	Absent		9,000	1,925	399	HC, IUB, and M-Y	4,825	2,250
17	0	Absent	Leiomyoma	7,350	1,365	809	HC	305	5,680
18	0	Absent	Twin pregnancy	18,000	2,500	729	HC, IUB	6,550	8,950

AIP: abnormally invasive placenta, CS: cesarean section, HC: holding the cervix, IUB: intrauterine balloon, and M-Y: Matsubara-Yano suture [12, 14]. Bleeding escaped into peritoneal cavity with little vaginal bleeding. In this case, transabdominal ultrasound revealed marked fluid collection in Morrison fossa, indicating the intraabdominal bleeding, which was confirmed later, and, thus, “305 mL” indicates “measurable vaginal bleeding.”