Aorta clamp to save lives during child birth

‘Paily aorta clamp’, developed by a Kerala obstetrician Dr. V.P. Paily, is providing good results without any incidence of vascular injury at multiple centres in low resource settings.

An aorta clamp developed by an obstetrician in the State to control torrential bleeding during the surgical management of Placenta Accreta Spectrum (PAS), a serious obstetric complication and a significant cause of maternal mortality, has been found to be quite useful in containing blood loss and saving maternal lives, without any incidence of vascular injury.

The “Paily aorta clamp”, developed by V. P. Paily, a senior obstetric consultant and a master trainer for the Kerala Federation of Obstetrics and Gynaecology, is currently being used in multiple centres across the State and a few centres outside Kerala, with good results.

A retrospective study of 33 women with varying grades of PAS, who underwent Caesarean hysterectomies as elective or emergency procedures utilising the Paily aorta clamp, appears in the March 2022 issue of the International Journal of Gynaecology and Obstetrics.

With the rise in Caesarean sections (C-section) across public as well as private sector hospitals, PAS is emerging as a major concern and is a significant cause of maternal mortality and morbidity. A previous C-section scar is the most typical risk factor for PAS as the placenta deeply adheres to the scar tissue and into the uterine wall, sometimes extending to nearby organs, such as the bladder.

This means that the placenta will not eject itself naturally after delivery and any attempts to remove it results in torrential haemorrhage (especially if encountered unexpectedly during delivery). Even when saved, the woman suffers catastrophic morbidity, including loss of uterus, bladder injuries, and fistula formations.

The condition has to be identified early during antenatal ultrasound scans and the woman has to be referred to a tertiary care centre for a planned Caesarean hysterectomy, to be done at 34-25 weeks.

PAS management is thus a nightmare for obstetricians worldwide because, apart from the risk of catastrophic amounts of blood loss, there is also the the high probability of urological injuries and massive transfusion requirements encountered during non-conservative surgery.