A 25-year-old woman with a high-risk pregnancy got a new lease of life thanks to a temporary aortic cross clamping method used by doctors at the State-run Vani Vilas hospital in Bengaluru to stop profuse bleeding.
Diagnosed with placenta previa, a serious obstetric complication and a significant cause of maternal mortality, the woman was referred to Vani Vilas from a smaller hospital. Apart from severe bleeding, she was sweating profusely. Her pulse rate was high, suggestive of tachycardia (a condition that makes the heart beat more than 100 times per minute), and her blood pressure was low.
Doctors rushed her to the high-risk pregnancy operation theatre. They were able to conduct a cesarean delivery by doing a temporary aortic cross clamping to stop the bleeding. This cross clamping, which is usually done in cardiac surgeries, is being used for the first time in a government facility in Karnataka, doctors claimed.
Patient suffered from a serious complication
M. Sathesha, Associate Professor of Anaesthesia at Vani Vilas, who was part of the team that handled this patient, said placenta previa is a serious complication wherein the placenta attaches low in the uterus. “This aorta clamp was developed by V.P. Paily, a senior obstetric consultant and a master trainer for the Kerala Federation of Obstetrics and Gynaecology. It has been found to be quite useful in containing blood loss,” the doctor explained.
“Called the Paily Aorta Clamp, this method is currently being used by multiple centres in Kerala. This was the first time it was used in a government hospital in Karnataka. We started using it a month ago and have so far been able to prevent complications in four women, including one emergency case,” the doctor said.
Maternal mortality
Savitha C., Vani Vilas Medical Superintendent, said placenta previa is emerging as a major concern and is a significant cause of maternal mortality and morbidity. “The placenta is an organ that develops inside the uterus during pregnancy. It provides oxygen and nutrition to the baby, and removes waste. The placenta connects to the baby through the umbilical cord. Typically, the placenta is attached to the top or side of the inner wall of the uterus. With placenta previa, the placenta attaches lower in the uterus,” she explained.
“A previous C-section scar is the most typical risk factor for this condition, as the placenta deeply adheres to the scar tissue and into the uterine wall, sometimes extending to nearby organs, such as the bladder,” she said.
“In such cases, the placenta will not eject itself naturally after delivery. Any attempt to remove it results in torrential hemorrhage, especially if encountered unexpectedly during delivery. Even when saved, the woman suffers catastrophic morbidity,” she explained.
Ashok Kumar Devoor, Associate Professor of OBG at Vani Vilas, claimed this clamping method was not being used in any hospital in Karnataka. “During a recent State-level meeting on emergency obstetric care, a doctor from Kerala told me about how this method is being used in many hospitals there to prevent severe blood loss on the table. We have ended up doing cesarean hysterectomies many times to save lives. With this method, we were able to save the uterus in all the four women with less than 200 ml of blood loss,” he said.
“Now after we posted our experience, many medical college hospitals are keen to use this method. With proper training, doctors can use it even in low resource settings,” the doctor added.
