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Robinson D, Basso M, Chan C, Duckitt K, Lett R. Guideline No. 431: Postpartum Hemorrhage and Hemorrhagic Shock. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1293-1310.e1. [PMID: 36567097 DOI: 10.1016/j.jogc.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This guideline aims to provide evidence for prevention, recognition, and treatment of postpartum hemorrhage including severe hemorrhage leading to hemorrhagic shock. TARGET POPULATION All pregnant patients. BENEFITS, HARMS, AND COSTS Appropriate recognition and treatment of postpartum hemorrhage can prevent serious morbidity while reducing costs to the health care system by minimizing more costly interventions and length of hospital stays. EVIDENCE Medical literature, PubMed, ClinicalTrials.gov, the Cochrane Database, and grey literature were searched for articles, published between 2012 and 2021, on postpartum hemorrhage, uterotonics, obstetrical hemorrhage, and massive hemorrhage protocols. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All members of the health care team who care for labouring or postpartum women, including, but not restricted to, nurses, midwives, family physicians, obstetricians, and anesthesiologists. RECOMMENDATIONS
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Robinson D, Basso M, Chan C, Duckitt K, Lett R. Directive clinique n o 431 : Hémorragie post-partum et choc hémorragique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1311-1329.e1. [PMID: 36567098 DOI: 10.1016/j.jogc.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Janisiewicz K, Mazurkiewicz B, Stefaniak M. Vaginal haematoma as a postpartum complication: a case report. MEDICAL SCIENCE PULSE 2022. [DOI: 10.5604/01.3001.0016.0922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
do uzupełnienia
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Affiliation(s)
- Katarzyna Janisiewicz
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Barbara Mazurkiewicz
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Małgorzata Stefaniak
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, Poland
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Zhang J, Chang H, Rockman C, Patel VI, Veeraswamy R, Berland T, Ramkhelawon B, Maldonado T, Cayne N, Jacobowitz G, Garg K. Hypogastric Artery Flow Interruption is Associated with Increased Mortality after Open Aortic Repair. Ann Vasc Surg 2022; 87:270-277. [PMID: 35654287 DOI: 10.1016/j.avsg.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Potential complications of pelvic flow disruption during aortic aneurysm repair include buttock ischemia and mesenteric ischemia. Unilateral or bilateral hypogastric artery flow interruption, either from atherosclerosis or intentionally to facilitate aneurysm repair, is considered problematic in endovascular repair; however, it has not been well studied in open abdominal aortic aneurysm (AAA) repair (OAR). We sought to examine the effect of interruption of flow to one or both hypogastric arteries on outcomes after OAR. METHODS The Society for Vascular Surgery Quality Initiative database was queried for all patients undergoing elective open AAA repair between 2003 and 2020. (redundant) Patients with appropriate data on their hypogastric arteries postoperatively were stratified into two groups - patent bilaterally (normal pelvic perfusion, NPP), and unilateral or bilateral occlusion or ligation (compromised pelvic perfusion, CPP). Primary endpoints were 30-day major morbidity (myocardial infarction, respiratory complications, renal injury, and lower extremity or intestinal ischemia) and mortality. RESULTS During the study period, 9.492 patients underwent elective open AAA repair - 860 (9.1%) with compromised pelvic perfusion and 8,632 (90.9%) with patent bilateral hypogastric arteries. The groups had similar cardiac risk factors, including history of coronary artery disease, prior coronary intervention and use of P2Y12 inhibitors and statins. A majority of patients in the CPP cohort had concurrent iliac aneurysms (63.3% versus 24.8%; p<.001). The perioperative mortality was significantly higher in patients with compromised pelvic perfusion (5.5% versus 3.1%; p<.001). Bilateral flow interruption had a trend toward higher perioperative mortality compared to unilateral interruption (7.1% versus 4.7%; p<.147). The CPP group also had increased rates of myocardial injury (6.7% versus 4.7%; p=.012), renal complications (18.9% versus 15.9%; p=.024), leg and bowel ischemia (3.5% versus 2.1%;, p=.008; and 5.7% versus 3.4%; p<.001, respectively). On multivariable analysis, CPP was associated with increased perioperative mortality (OR 1.47, CI 1.14-1.88, p=.003). On Kaplan-Meier analysis, there was no difference in survival at 2 years post discharge, between the NPP and CPP cohorts (86.1% versus 87.5%, logrank-p=0.275). CONCLUSIONS Compromised pelvic perfusion is associated with increased perioperative complications and higher mortality in patients undergoing OAR. The sequalae of losing pelvic perfusion in addition to the presence of more complex atherosclerotic and aneurysmal disease resulting in more difficult dissection likely contribute to these findings. Thus, patients considered for OAR who have occluded hypogastric arteries or aneurysmal involvement of the hypogastric artery preoperatively may be candidates for more conservative management beyond traditional size criteria.
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Affiliation(s)
- Jason Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY 10016
| | - Heepeel Chang
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY 10016
| | - Caron Rockman
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY 10016
| | - Virendra I Patel
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian / Columbia University Irving Medical Center / Columbia University College of Physicians and Surgeons, New York, NY 10032
| | - Ravi Veeraswamy
- Division of Vascular and Endovascular Surgery, Medical University of South Carolina, Charleston, SC 29425
| | - Todd Berland
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY 10016
| | - Bhama Ramkhelawon
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY 10016
| | - Thomas Maldonado
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY 10016
| | - Neal Cayne
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY 10016
| | - Glenn Jacobowitz
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY 10016
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY 10016.
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Isono W, Tsuchiya A, Okamura A, Honda M, Saito A, Tsuchiya H, Matsuyama R, Fujimoto A, Nishii O. Unilateral uterine artery embolization and Bakri tamponade balloon insertion in the treatment of acute puerperal uterine inversion: a case report. J Med Case Rep 2022; 16:190. [PMID: 35562769 PMCID: PMC9107129 DOI: 10.1186/s13256-022-03419-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background Acute puerperal uterine inversion is rare but may cause massive postpartum blood loss due to uterine atony. Therefore, these patients must be diagnosed, and uterine replacement must be performed as soon as possible. However, in some cases, active bleeding due to uterine atony becomes uncontrollable, even though the uterine inversion itself is treated. In these cases, additional treatments, including surgical procedures, are needed. Case presentation A 41-year-old Japanese woman, gravida 1, para 0, was hospitalized for labor induction at 40 weeks and 3 days of gestational age. She had a vacuum-assisted delivery after 3 days of oxytocin administration, but acute uterine inversion occurred. Although replacement of the inverted uterus was successful by manual repositioning and Bakri balloon tamponade insertion, massive postpartum hemorrhage caused by uterine atony became uncontrollable. In this situation, since disseminated intravascular coagulation had developed, we used uterine artery embolization to stop the bleeding. After detecting the pseudo-aneurysmal sac and tortuous vessels of the right uterine artery, transcatheter right-sided uterine artery embolization was performed. Thirteen days after uterine artery embolization, she was discharged with no complications. Conclusions In cases of disseminated intravascular coagulation caused by massive postpartum bleeding, uterine artery embolization may often be selected. In our case, since we performed angiography to detect the main bleeding site, the hemorrhage could be stopped with unilateral uterine artery embolization alone, without hysterectomy.
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Affiliation(s)
- Wataru Isono
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan.
| | - Akira Tsuchiya
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Asuka Okamura
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Michiko Honda
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Ako Saito
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Hiroko Tsuchiya
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Reiko Matsuyama
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Akihisa Fujimoto
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Osamu Nishii
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
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Liu W, Yin W. Effect of Uterine Artery Ligation and Uterine Artery Embolization on Postpartum Hemorrhage Due to Uterine Asthenia after Cesarean Section and Its Effect on Blood Flow and Function of Uterine and Ovarian Arteries. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1337234. [PMID: 35356624 PMCID: PMC8959990 DOI: 10.1155/2022/1337234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/04/2022] [Indexed: 01/10/2023]
Abstract
Objective To investigate the efficacy of uterine artery ligation (UAL) and uterine artery embolization (UAE) in the treatment of uterine asthenia postpartum hemorrhage (PPH) after cesarean section and its effect on uterine and ovarian artery blood flow and function. Methods 100 patients with uterine asthenia PPH after cesarean section in our hospital from January 2018 to November 2020 were randomly divided into 50 cases in the UAL group and 50 cases in the UAE group. They were followed up for 12 months. The bleeding volume, operation time, immediate hemostasis rate, and hemostasis effective rate; lochia clearance time and menstrual rehydration time; RI and S/D; and serum FSH, E2, and LH levels were compared between the two groups. Results Compared with the UAL group, the amount of bleeding in the UAE group was significantly increased and the operation time was significantly shortened (p < 0.05). There was no significant difference in the immediate hemostatic rate and hemostatic effective rate between the two groups (p > 0.05). There was no significant difference in lochia clearance time and menstrual rehydration time between the two groups (p > 0.05). There was no significant difference in RI and S/D between the two groups (p > 0.05). Compared with before the operation, the levels of FSH and LH in the two groups decreased significantly, and the level of E2 increased significantly (p < 0.05). There was no significant difference between the two groups (p > 0.05). Conclusion The efficacy of UAL and UAE in the treatment of PPH with uterine asthenia after cesarean section and its effect on the blood flow and function of uterine and ovarian arteries are equivalent, but the amount of bleeding in UAL is less and the operation time of UAE is shorter. The appropriate operation method can be selected according to the actual situation.
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Affiliation(s)
- Wufen Liu
- Obstetrics and Reproductive Center, Affiliated Hospital of Yunnan University, Kunming 650021, China
| | - Wei Yin
- Obstetrics and Reproductive Center, Affiliated Hospital of Yunnan University, Kunming 650021, China
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Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D, Lloyd I, Chandraharan E, Miller S, Burke T, Ossanan G, Andres Carvajal J, Ramos I, Hincapie MA, Loaiza S, Nasner D. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet 2022; 157 Suppl 1:3-50. [PMID: 35297039 PMCID: PMC9313855 DOI: 10.1002/ijgo.14116] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Maria Fernanda Escobar
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Tygerberg Hospital, Cape Town, South Africa
| | - Eythan R Barnea
- Society for Investigation or Early Pregnancy (SIEP), New York, New York, USA
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Diana Ramasauskaite
- Center of Obstetrics and Gynecology, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Isabel Lloyd
- Department of Obstetrics and Gynecology, Universidad de Panamá, Panama City, Panamá.,Hospital Santo Tomas, Panama City, Panamá
| | - Edwin Chandraharan
- Department of Obstetrics and Gynecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Thomas Burke
- Division of Global Health and Human Rights, Massachusetts General Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, USA
| | - Gabriel Ossanan
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Javier Andres Carvajal
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Isabella Ramos
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Maria Antonia Hincapie
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Sara Loaiza
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Daniela Nasner
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
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- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia
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Li YT, Chang WH, Wang PH. Postpartum hemorrhage. Taiwan J Obstet Gynecol 2022; 61:5-7. [PMID: 35181045 DOI: 10.1016/j.tjog.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Yiu-Tai Li
- Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan
| | - Wen-Hsun Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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Tseng JY, Lin IC, Lin JH, Chang CM, Chao WT, Wang PH. Optimal approach for management of postpartum vulva hematoma: Report of three cases. Taiwan J Obstet Gynecol 2021; 59:780-783. [PMID: 32917338 DOI: 10.1016/j.tjog.2020.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Vulvar hematomas though common in obstetrical practice can rapidly evolve into a life-threatening condition if not managed appropriately. Depending on clinical status and medical facility, conservative management, surgical debridement, or vessel-occlusion strategy can be considered. CASE REPORT Case 1 was a 28 year-old pregnant woman. Increasing hematoma over 12 cm in size was noted on postpartum Day 2. Debridement and arterial embolization were done. Case 2 was a referred woman at age of 30 who delivered at a local obstetric clinic. Debridement was performed successfully. Case 3 was a 23 year-old woman with postpartum bilateral hematoma. Drop in hemoglobin level prompted the medical team to transfer and airlift the patient for arterial embolization and subsequent vulva debridement. CONCLUSION Optimal management of hematoma is dependent on maternal hemodynamic condition, bleeding status, and availability of interventional radiology.
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Affiliation(s)
- Jen-Yu Tseng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - I-Chia Lin
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Jun-Hung Lin
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Chia-Ming Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Wei-Ting Chao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, School of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Female Cancer Foundation, Taipei, Taiwan.
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Horng HC, Lai MJ, Chang WH, Wang PH. Placenta accreta spectrum (PAS) and peripartum hysterectomy. Taiwan J Obstet Gynecol 2021; 60:395-396. [PMID: 33966717 DOI: 10.1016/j.tjog.2021.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- Huann-Cheng Horng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Man-Jung Lai
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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İçen MS, Findik FM, Akin Evsen G, Ağaçayak E, Yaman Tunç S, Evsen MS, Gül T. Hypogastric artery ligation in postpartum haemorrhage: a ten-year experience at a tertiary care centre. J OBSTET GYNAECOL 2020; 41:536-540. [PMID: 32496842 DOI: 10.1080/01443615.2020.1755623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study investigated patients who underwent bilateral hypogastric artery ligation (BHAL) due to postpartum haemorrhage (PPH). Patients who underwent BHAL because of PPH following a conservative treatment were included in this study. Placental abnormalities were referred to as placenta accreta. A total of 130 BHAL procedures took place at the study hospital as a result of PPH. Of these, 39 (30%) were referred to the hospital. The rate of BHAL requirement was 62 out of 10,000 births. Among the 130 patients, the most frequent indication for BHAL was placenta accreta (58.5%). Haematological parameters were poorer among the referral patients. Four of the exitus patients (80%) were referral patients. The mortality rate among the referral patients was 10.25%, whereas this rate was only 1.01% among the patients who gave birth at the hospital. PPH is a life-threatening condition that requires immediate medical attention. BHAL, with its fertility-preserving features, is a good option that can be employed in all PPH patients. BHAL not only preserves patients' fertility, but it also gives them a higher chance of survival.IMPACT STATEMENTWhat is already known on this subject? PPH is a life-threatening condition. Due to the worldwide increase in caesarean sections, placenta accreta has also increased. BHAL is a vital treatment method for PPH.What do the results of this study add? Placenta accreta is one of the most common causes of PPH. Traditional hysterectomy rates can be reduced by replacing this treatment with BHAL in this group of patients. Without early intervention in PPH, a patient's mortality risk can increase by up to 10 times. As research and surgeons' experience grows, PPH can be controlled with treatments with less complex modalities without the need for BHAL.What are the implications of these findings for clinical practice and/or further research? The need for BHAL should be kept in mind when addressing PPH, especially in cases of placenta accreta. The need for hypogastric artery ligation, which is a more aggressive treatment for the surgical correction of the pathology, can be reduced as surgeons' experience increases. Early intervention and/or referral in cases of PPH is of great importance.
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Affiliation(s)
- Mehmet Sait İçen
- Department of Gynecology and Obstetrics, Medical Faculty of Dicle University, Diyarbakir, Turkey
| | - Fatih Mehmet Findik
- Department of Gynecology and Obstetrics, Medical Faculty of Dicle University, Diyarbakir, Turkey
| | - Gamze Akin Evsen
- Department of Gynecology and Obstetrics, Medical Faculty of Dicle University, Diyarbakir, Turkey
| | - Elif Ağaçayak
- Department of Gynecology and Obstetrics, Medical Faculty of Dicle University, Diyarbakir, Turkey
| | - Senem Yaman Tunç
- Department of Gynecology and Obstetrics, Medical Faculty of Dicle University, Diyarbakir, Turkey
| | - Mehmet Sıddık Evsen
- Department of Gynecology and Obstetrics, Medical Faculty of Dicle University, Diyarbakir, Turkey
| | - Talip Gül
- Department of Gynecology and Obstetrics, Medical Faculty of Dicle University, Diyarbakir, Turkey
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Hsu YH, Yeh CC, Wang PH. The better way-uterine feeding vessel occlusion to manage postpartum hemorrhage. Taiwan J Obstet Gynecol 2019; 58:175-176. [PMID: 30910133 DOI: 10.1016/j.tjog.2019.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yueh-Han Hsu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan
| | - Chang-Ching Yeh
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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