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Cordeiro Féria B, Nazaré P, Figueiredo J, Neves Gomes I, Pereira A. Efficacy, Complications and Effects of Alcides Pereira's Sutures in the Management of Uterine Atony: A Retrospective Study. ACTA MEDICA PORT 2024. [PMID: 38447018 DOI: 10.20344/amp.20429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/08/2023] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Uterine compressive sutures are conservative measures applied in cases of severe postpartum hemorrhage unresponsive to uterotonics. Pereira's suture was introduced in 2005 and consists of two longitudinal and three transverse non-transfixes sutures. Previous studies reported favorable results, highlighting its benefits and value. The aim of this study was to assess the efficacy, complications, and impact on fertility and future pregnancies of Pereira's suture applied in cases of uterine atony and postpartum hemorrhage. METHODS An observational retrospective study was performed by consulting the medical records of women treated with Pereira's compressive sutures in a tertiary center between January 2013 and December 2022. We registered demographic data, pregnancy outcomes, short-term complications, and outcomes of subsequent pregnancies. RESULTS A total of 50 women were treated with Pereira's suture. The overall success rate was 96% and no hysterectomies were performed. Women who had sutures performed during an intra-cesarean section had better outcomes than those who had an after-cesarean section. Complications were reported in 12% (n = 6) of women, with the most frequent being pelvic infection (n = 3) and abdominal pain (n = 3). Regarding fertility, all women desiring a future pregnancy (n = 5) were able to conceive, resulting in three live births. CONCLUSION Pereira's suture is a type of suture that provides numerous advantages and should be considered when first-line medical treatment fails. When applied at an early stage, the sutures may prevent maternal morbidity. The Alcides Pereira's suture is a safe technique and appears to preserve fertility.
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Affiliation(s)
| | - Patrícia Nazaré
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
| | - Joana Figueiredo
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
| | - Inês Neves Gomes
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
| | - Alcides Pereira
- Serviço de Ginecologia e Obstetrícia. Hospital Garcia de Orta. Almada. Portugal
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Bouchghoul H, Madar H, Resch B, Pineles BL, Mattuizzi A, Froeliger A, Sentilhes L. Uterine-sparing surgical procedures to control postpartum hemorrhage. Am J Obstet Gynecol 2024; 230:S1066-S1075.e4. [PMID: 37729440 DOI: 10.1016/j.ajog.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/05/2022] [Accepted: 06/12/2022] [Indexed: 09/22/2023]
Abstract
Postpartum hemorrhage remains one of the principal causes of maternal mortality in the United States and throughout the world. Its management, which must be multidisciplinary (obstetrics, midwifery, anesthesiology, interventional radiology, and nursing), depends on the speed of both diagnosis and implementation of medical and surgical treatment to control the hemorrhage. The aim of this work is to describe the various techniques of vessel ligation and of uterine compression for controlling and treating severe hemorrhage, and to present the advantages and disadvantages of each. It is not difficult to perform vessel ligation of the uterine arteries: O'Leary's bilateral ligation of the uterine artery, Tsirulnikov's triple ligation, and AbdRabbo's stepwise uterine devascularization (that is, stepwise triple ligation). These procedures are associated with a high success rate (approximately 90%) and a low complication rate. Bilateral ligation of the internal iliac (hypogastric) arteries is more difficult to perform and potentially less effective (approximately 70% effectiveness) than the previously mentioned procedures. Its complication rate is low, but the complications are most often serious. There is no evidence that future fertility or subsequent obstetrical outcomes are impaired by ligation of either the uterine or internal iliac arteries. There are many techniques used for uterine compression sutures, and none has shown clear superiority to another. Uterine compression suture has an effectiveness rate of approximately 75% after failure of medical treatment and approximately 80% as a second-line procedure after unsuccessful vessel ligation. The risk of synechiae after uterine compression suture has not yet been adequately evaluated, but is probably around 5%. The risk of synechiae after uterine compression suture has not yet been adequately evaluated, but probably ranges between 5% and 10%. The methodologic quality of the studies assessing uterine-sparing surgical procedures remains limited, with no comparative studies. Accordingly, no evidence suggests that any one of these methods is better than any other. Accordingly, the choice of surgical technique to control hemorrhage must be guided firstly by the operator's experience. If the hemorrhage continues after a first-line uterine-sparing surgical procedure and the patient remains hemodynamically stable, a second-line procedure can be chosen. Nonetheless, the application of these procedures must not delay the performance of a peripartum hysterectomy in cases of hemodynamic instability.
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Affiliation(s)
- Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Benoit Resch
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France; Department of Gynecologic Surgery, Clinique Mathilde, Rouen, France
| | - Beth L Pineles
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, TX
| | - Aurélien Mattuizzi
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Alizée Froeliger
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
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3
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Denizli R, Farısoğulları N, Sakcak B, Özkavak OO, Kara Ö, Tanaçan A, Şahin D. Comparison of H-Hayman uterine compression suture with conventional vertical sutures: A cross-sectional study in a tertiary center. Int J Gynaecol Obstet 2023; 163:123-130. [PMID: 37415278 DOI: 10.1002/ijgo.14985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To compare H-Hayman, a modified uterine compression suturing technique (UCS) that we describe for the first time in the literature, with conventional vertical UCS techniques. METHODS The H-Hayman technique was used in 14 women and the conventional UCS technique in 21 women. In order to provide standardization in the study, only patients who had developed upper-segment atony during cesarean section were recruited for the study. RESULTS Bleeding control was achieved in 85.7% (12/14) of the cases using the H-Hayman technique. In the remaining two patients with persistent hemorrhage in this group, bleeding control was provided with bilateral uterine artery ligation, and a hysterectomy was avoided in all cases. With the conventional technique, bleeding control was achieved in 76.1% (16/21) of the patients, and the overall success rate was 95.2% after bilateral uterine artery ligation in those with persistent hemorrhage. In addition, the estimated blood loss and the need for erythrocyte suspension transfusion were significantly lower in the H-Hayman group (P = 0.01 and P = 0.04, respectively). CONCLUSION We found the H-Hayman technique to be at least as successful as conventional UCS. In addition, patients who underwent suturing with the H-Hayman technique had less blood loss and a lower requirement for erythrocyte suspension transfusion.
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Affiliation(s)
- Ramazan Denizli
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Nihat Farısoğulları
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Bedri Sakcak
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Osman Onur Özkavak
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Özgür Kara
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanaçan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Dilek Şahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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4
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Post SE, Rood KM, Kiefer MK. Interventions of Postpartum Hemorrhage. Clin Obstet Gynecol 2023; 66:367-383. [PMID: 37204172 DOI: 10.1097/grf.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Postpartum hemorrhage is a common and potentially life-threatening obstetric complication, with successful management relying heavily on early identification of hemorrhage and prompt intervention. This article will review the management of postpartum hemorrhage, including initial steps, exam-specific interventions, medical therapy, minimally invasive, and surgical interventions.
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Affiliation(s)
- Sara E Post
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, Ohio
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García-Guerra R, Assaf-Balut M, El-Bakkali S, de Ávila-Benavides IP, Huertas-Fernández MÁ. Uterine necrosis following hemostatic compression suture: case report and review of the literature. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2022; 73:378-387. [PMID: 36637386 PMCID: PMC9856609 DOI: 10.18597/rcog.3856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Abstract
Objectives To present a case of uterine necrosis following hemostatic suturing to control postpartum bleeding, and to review the literature in order to identify the suture techniques employed, clinical findings, diagnostics and treatment in the clinical cases described. Material and methods A 34-year-old woman presenting with abdominal pain eight days after cesarean delivery due to placenta previa who required B-Lynch compression suture due to uterine atony, and who was diagnosed with uterine necrosis. The patient underwent total abdominal hysterectomy with a satisfactory recovery. A systematic literature search was conducted in the Medline vía Pubmed, Embase and Web of Science databases. The search included case series and reports, and cohorts of women with uterine necrosis following the use of uterine compression sutures for postpartum bleeding. The analysis included sociodemographic and clinical variables at the time of diagnosis, suturing technique, diagnostic tests and treatment. Results Overall, 23 studies with 24 patients were included. Of all necrosis cases, 83% occurred following cesarean section. B-Lynch was the suturing technique most frequently used (66 %), followed by the Cho suture (25 %). The most frequent symptoms were fever and abdominal pain. The most commonly used diagnostic test was computed tomography (9/24 cases). Hysterectomy was performed in the majority of cases (75 %). Conclusions Although rare, uterine wall necrosis is a serious complication. It would be advisable to design follow-up cohort studies of women undergoing these procedures in order to determine the incidence of associated complications.
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Affiliation(s)
- Raquel García-Guerra
- Especialista en Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).Hospital Universitario de GetafeMadridEspaña, Correspondencia: Raquel García-Guerra. Hospital Universitario de Getafe, Carr. Madrid-Toledo, km 12,500, 28905, Getafe, Madrid (España). Correo electrónico:
| | - Myrna Assaf-Balut
- Residente de Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).Hospital Universitario de GetafeMadridEspaña
| | - Sara El-Bakkali
- Especialista en Ginecología y Obstetricia, Hospital Universitario Ibn Sina, Rabat (Marruecos).Hospital Universitario Ibn SinaRabatMarruecos
| | - Irene Pérez de Ávila-Benavides
- Jefa de sección de Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).Hospital Universitario de GetafeMadridEspaña
| | - Miguel Ángel Huertas-Fernández
- Jefe de servicio de Ginecología y Obstetricia, Hospital Universitario de Getafe, Madrid (España).Hospital Universitario de GetafeMadridEspaña
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6
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Conservative surgical treatment of post-partum hemorrhage: Should we reconsider compression penetrating sutures? J Gynecol Obstet Hum Reprod 2022; 51:102495. [DOI: 10.1016/j.jogoh.2022.102495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
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7
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Matsubara S. Pereira uterine compression suture: Visiting old, learn new. Eur J Obstet Gynecol Reprod Biol 2022; 277:122-123. [PMID: 36064488 DOI: 10.1016/j.ejogrb.2022.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan; Department of Obstetrics and Gynecology, Koga Red Cross Hospital, 1150 Shimoyama, Koga, Ibaraki 306-0014, Japan.
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8
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Uterine preservation with Alcides-Pereira's compressive sutures for postpartum uterine atony. Eur J Obstet Gynecol Reprod Biol 2022; 277:27-31. [PMID: 35987075 DOI: 10.1016/j.ejogrb.2022.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/31/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Postpartum hemorrhage (PPH) is mostly caused by uterine atony and is the leading cause of maternal death. Hysterectomy may be necessary in severe cases, but uterine compressive sutures are an uterine-sparing alternative. In 2005, Alcides Pereira proposed a technique with serial superficial stiches around the uterus. To date, there were no further reports on its clinical use. OBJECTIVE To evaluate a tertiary center's experience with Alcides-Pereira's compressive uterine sutures for severe PPH due to uterine atony, reviewing its efficacy, morbidity, and impact on reproductive outcomes. STUDY DESIGN An 11-year retrospective cohort study of Alcides-Pereira's sutures for PPH at a single tertiary hospital. Demographic and obstetric data were collected. Details of subsequent pregnancies and fertility plans were collected through a telephonic interview. Comparison between women in which the sutures were effective and ineffective to prevent hysterectomy was made. RESULTS Alcides-Pereira's sutures were applied in 23 patients with PPH due to uterine atony. The technique was successful in controlling the hemorrhage and avoiding hysterectomy in 20 patients (87%). When successful, the sutures avoided the need for any blood therapy in 55% (RR 0.45, 95% CI 0.28-0.73) of patients, intensive care unit admission in 80% (RR 0.2, 95% CI 0.08-0.48) and significantly shortened the length of hospital stay. All patients with preserved uterus resumed their usual menstrual pattern. One had a subsequent term vaginal delivery; one had three first trimester miscarriages. All other patients did not try to conceive. CONCLUSION Alcides-Pereira's sutures are a feasible, uterine-sparing technique, providing an effective and safe option for PPH.
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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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10
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Yıldırım MA, Kavak SB, Kurkut B, Sanli C, Batmaz I, Bulu G. Comparison of a novel isthmic circumferential suture and Bakri balloon technique for the treatment of uterine atony during cesarean section. J Matern Fetal Neonatal Med 2021; 35:7737-7743. [PMID: 34362277 DOI: 10.1080/14767058.2021.1961724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postpartum bleeding is a life-threatening obstetric complication. The most common cause is uterine atony. There is no method that can treat PPH with 100% effectiveness and therefore, efforts for the development of more effective conservative treatment methods continue. The aim of the study is to compare the effectiveness of the isthmic circumferential suture technique and the Bakri balloon tamponade in the treatment of postpartum bleeding due to uterine atony during cesarean operation. METHODS This study was conducted by retrospectively evaluating the cases who developed uterine atony during cesarean section. Group 1 (n = 15) consisted of the patients who had undergone the isthmic circumferential suture technique, and Group 2 (n = 15) comprised patients who had undergone the Bakri balloon tamponade. The two groups were compared with regard to obstetric characteristics, operative time, preoperative and postoperative features, and neonatal outcomes. RESULTS The groups were similar with regard to age, obstetric characteristics, preoperative complete blood count, neonatal outcomes and there was no statistically significant difference between groups. The operative time was significantly shorter in Group 1 (61.86 ± 6.7 vs. 69.53 ± 3.2 min; p < .05). The amount of intraoperative bleeding was lower in Group 1, although there was no statistically significant difference (1793.66 ± 323.96 versus 1886.33 ± 343.23 ml; p > .05). The postoperative blood loss was significantly less in Group 1 compared to Group 2 (101.37 ± 64.6 versus 169.32 ± 50.0 ml; p < .05). The postoperative 24-hour Htc values were significantly higher in Group 1 (28.83 ± 2.1 versus 27.08 ± 2.1 g/dl; p < .05). CONCLUSION Both methods are effective in the uterine atony during cesarean section. However, due to the shorter operative time and less pre-operative blood loss, the isthmic circumferential suture technique may be a better alternative.
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Affiliation(s)
- Mem Arjen Yıldırım
- Department of Obstetrics and Gynecology, Private Cihanpol Hospital, Kızıltepe, Turkey
| | - Salih Burcin Kavak
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Bülent Kurkut
- Department of Obstetrics and Gynecology, Private Cihanpol Hospital, Kızıltepe, Turkey
| | - Cengiz Sanli
- Department of Obstetrics and Gynecology, Fethi Sekin City Hospital, Elazig, Turkey
| | - Ibrahim Batmaz
- Department of Obstetrics and Gynecology, Hani State Hospital, Diyarbakir, Turkey
| | - Gulay Bulu
- Department of Obstetrics and Gynecology, Kovancılar State Hospital, Elazig, Turkey
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11
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Çalışkan E, Akar B, Ceylan Y, Karadağ C. A novel low uterine segment sandwich technique (Caliskan's technique) for the management of post-cesarean hemorrhage due to placenta previa accreta. Turk J Obstet Gynecol 2021; 18:79-84. [PMID: 34082519 PMCID: PMC8191321 DOI: 10.4274/tjod.galenos.2021.72437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Placenta previa (PP) and placenta accreta spectrum (PAS) disorders are major causes of postpartum hemorrhage (PPH). There is a variety of surgical management options with inexplicit reported success rates. Uterine sandwich is a combination of uterine compression sutures and intrauterine balloon placement to achieve hemostasis. The aim of this study was to present our experience of seven women managed with a novel “lower uterine sandwich” technique to control post-cesarean hemorrhage due to PP accreta. Materials and Methods: Seven pregnant women diagnosed as having PP totalis accreta underwent a post-cesarean procedure combining bilateral ligation of the uterine artery, utero-ovarian artery, and internal iliac artery, Pereira compression sutures implemented on the uterine isthmus, Foley catheter placement into the lower uterine segment, and transvaginal cervical cerclage application, namely “Caliskan’s uterine sandwich technique”. Results: All women included in this study had placental invasion abnormalities of varying degrees. Postoperative diffusion magnetic resonance imaging assessment revealed a completely normal and preserved uterine blood supply. All women menstruated regularly in their postoperative follow-up period and two women conceived again and delivered uneventfully. None of the patients experienced morbid complications nor required hysterectomy. Conclusion: This novel procedure appears to be a plausible fertility and organ-preserving option in cases of intractable PPH, particularly in lower uterine segment bleeding. This uterine sandwich technique may allow physicians to manage massive hemorrhage due to PAS conservatively by preserving the uterus and its functions without major complications.
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Affiliation(s)
- Eray Çalışkan
- Okan University School of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Bertan Akar
- İstinye University School of Medicine, Private Kocaeli Hospital, Clinic of Obstetrics and Gynecology, Kocaeli, Turkey
| | - Yasin Ceylan
- Kocaeli University School of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey
| | - Cihan Karadağ
- Okan University School of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
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12
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Affiliation(s)
- Jessica L Bienstock
- From the Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore
| | - Ahizechukwu C Eke
- From the Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore
| | - Nancy A Hueppchen
- From the Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore
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13
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Moussaoui KE, Zraidi N, Baidada A, Kharbach A. [Uterine necrosis following uterine compressions in combination with vascular ligation during postpartum hemorrhage: a case report]. Pan Afr Med J 2020; 37:279. [PMID: 33598093 PMCID: PMC7864268 DOI: 10.11604/pamj.2020.37.279.26788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/11/2020] [Indexed: 11/20/2022] Open
Abstract
L'hémorragie de délivrance reste la première cause de mortalité maternelle au Maroc, c´est une urgence obstétricale qui nécessite une prise en charge rapide, efficace et multidisciplinaire. Dans les cas d´hémorragie du post-partum grave rebelle au traitement médical, les progrès de la radiologie interventionnelle et surtout des techniques chirurgicales ont fourni des alternatives sûres et efficaces à l'hystérectomie d´hémostase. On rapporte un cas de nécrose utérine suite à un traitement conservateur chirurgicale de l´hémorragie de délivrance à base d´une combinaison de technique de compression utérine type B-Lynch et triple ligature vasculaire de Tsirulnikov. La patiente a présenté un tableau de sepsis a J4 du post-partum avec un état fébrile et des douleurs pelviennes et un syndrome inflammatoire biologique qui s´est aggravé 48 heures après par l´apparition de contracture abdominale. Le scanner abdomino-pelvien a montré des bulles de gaz dans le myomètre utérin évoquant une nécrose. Une laparotomie exploratoire a été réalisée, l'exploration a révélé une nécrose complète de l'utérus. Les techniques chirurgicales des sutures de compression utérine jouent un rôle majeur dans l'arsenal thérapeutique de l'hémorragie post-partum pendant la césarienne. Elle permet, en complément ou en alternative à la ligature vasculaire, la préservation de la fertilité de la patiente mais elle nécessite également une prudence et une surveillance maximale des complications dont la plus grave est la nécrose utérine.
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Affiliation(s)
- Kamal El Moussaoui
- Département de Gynécologie Obstétrique, Maternité Souissi, CHU Ibn Sina, Rabat, Maroc
| | - Najia Zraidi
- Département de Gynécologie Obstétrique, Maternité Souissi, CHU Ibn Sina, Rabat, Maroc
| | - Aziz Baidada
- Département de Gynécologie Obstétrique, Maternité Souissi, CHU Ibn Sina, Rabat, Maroc
| | - Aicha Kharbach
- Département de Gynécologie Obstétrique, Maternité Souissi, CHU Ibn Sina, Rabat, Maroc
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A Uterus-Preserving Treatment for Uncontrollable Postpartum Hemorrhage: Esike's Technique. Obstet Gynecol 2020; 136:1065-1066. [PMID: 33093417 DOI: 10.1097/aog.0000000000004154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Kellie FJ, Wandabwa JN, Mousa HA, Weeks AD. Mechanical and surgical interventions for treating primary postpartum haemorrhage. Cochrane Database Syst Rev 2020; 7:CD013663. [PMID: 32609374 PMCID: PMC8407481 DOI: 10.1002/14651858.cd013663] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Primary postpartum haemorrhage (PPH) is commonly defined as bleeding from the genital tract of 500 mL or more within 24 hours of birth. It is one of the most common causes of maternal mortality worldwide and causes significant physical and psychological morbidity. An earlier Cochrane Review considering any treatments for the management of primary PPH, has been split into separate reviews. This review considers treatment with mechanical and surgical interventions. OBJECTIVES To determine the effectiveness and safety of mechanical and surgical interventions used for the treatment of primary PPH. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (26 July 2019) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of mechanical/surgical methods for the treatment of primary PPH compared with standard care or another mechanical/surgical method. Interventions could include uterine packing, intrauterine balloon insertion, artery ligation/embolism, or uterine compression (either with sutures or manually). We included studies reported in abstract form if there was sufficient information to permit risk of bias assessment. Trials using a cluster-RCT design were eligible for inclusion, but quasi-RCTs or cross-over studies were not. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and risk of bias, independently extracted data and checked data for accuracy. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included nine small trials (944 women) conducted in Pakistan, Turkey, Thailand, Egypt (four trials), Saudi Arabia, Benin and Mali. Overall, included trials were at an unclear risk of bias. Due to substantial differences between the studies, it was not possible to combine any trials in meta-analysis. Many of this review's important outcomes were not reported. GRADE assessments ranged from very low to low, with the majority of outcome results rated as very low certainty. Downgrading decisions were mainly based on study design limitations and imprecision; one study was also downgraded for indirectness. External uterine compression versus normal care (1 trial, 64 women) Very low-certainty evidence means that we are unclear about the effect on blood transfusion (risk ratio (RR) 2.33, 95% confidence interval (CI) 0.66 to 8.23). Uterine arterial embolisation versus surgical devascularisation plus B-Lynch (1 trial, 23 women) The available evidence for hysterectomy to control bleeding (RR 0.73, 95% CI 0.15 to 3.57) is unclear due to very low-certainty evidence. The available evidence for intervention side effects is also unclear because the evidence was very low certainty (RR 1.09; 95% CI 0.08 to 15.41). Intrauterine Tamponade Studies included various methods of intrauterine tamponade: the commercial Bakri balloon, a fluid-filled condom-loaded latex catheter ('condom catheter'), an air-filled latex balloon-loaded catheter ('latex balloon catheter'), or traditional packing with gauze. Balloon tamponade versus normal care (2 trials, 356 women) One study(116 women) used the condom catheter. This study found that it may increase blood loss of 1000 mL or more (RR 1.52, 95% CI 1.15 to 2.00; 113 women), very low-certainty evidence. For other outcomes the results are unclear and graded as very low-certainty evidence: mortality due to bleeding (RR 6.21, 95% CI 0.77 to 49.98); hysterectomy to control bleeding (RR 4.14, 95% CI 0.48 to 35.93); total blood transfusion (RR 1.49, 95% CI 0.88 to 2.51); and side effects. A second study of 240 women used the latex balloon catheter together with cervical cerclage. Very low-certainty evidence means we are unclear about the effect on hysterectomy (RR 0.14, 95% CI 0.01 to 2.74) and additional surgical interventions to control bleeding (RR 0.20, 95% CI 0.01 to 4.12). Bakri balloon tamponade versus haemostatic square suturing of the uterus (1 trial, 13 women) In this small trial there was no mortality due to bleeding, serious maternal morbidity or side effects of the intervention, and the results are unclear for blood transfusion (RR 0.57, 95% CI 0.14 to 2.36; very low certainty). Bakri balloon tamponade may reduce mean 'intraoperative' blood loss (mean difference (MD) -426 mL, 95% CI -631.28 to -220.72), very low-certainty evidence. Comparison of intrauterine tamponade methods (3 trials, 328 women) One study (66 women) compared the Bakri balloon and the condom catheter, but it was uncertain whether the Bakri balloon reduces the risk of hysterectomy to control bleeding due to very low-certainty evidence (RR 0.50, 95% CI 0.05 to 5.25). Very low-certainty evidence also means we are unclear about the results for the risk of blood transfusion (RR 0.97, 95% CI 0.88 to 1.06). A second study (50 women) compared Bakri balloon, with and without a traction stitch. Very low-certainty evidence means we are unclear about the results for hysterectomy to control bleeding (RR 0.20, 95% CI 0.01 to 3.97). A third study (212 women) compared the condom catheter to gauze packing and found that it may reduce fever (RR 0.47, 95% CI 0.38 to 0.59), but again the evidence was very low certainty. Modified B-Lynch compression suture versus standard B-Lynch compression suture (1 trial, 160 women) Low-certainty evidence suggests that a modified B-Lynch compression suture may reduce the risk of hysterectomy to control bleeding (RR 0.33, 95% CI 0.11 to 0.99) and postoperative blood loss (MD -244.00 mL, 95% CI -295.25 to -192.75). AUTHORS' CONCLUSIONS There is currently insufficient evidence from RCTs to determine the relative effectiveness and safety of mechanical and surgical interventions for treating primary PPH. High-quality randomised trials are urgently needed, and new emergency consent pathways should facilitate recruitment. The finding that intrauterine tamponade may increase total blood loss > 1000 mL suggests that introducing condom-balloon tamponade into low-resource settings on its own without multi-system quality improvement does not reduce PPH deaths or morbidity. The suggestion that modified B-Lynch suture may be superior to the original requires further research before the revised technique is adopted. In high-resource settings, uterine artery embolisation has become popular as the equipment and skills become more widely available. However, there is little randomised trial evidence regarding efficacy and this requires further research. We urge new trial authors to adopt PPH core outcomes to facilitate consistency between primary studies and subsequent meta-analysis.
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Affiliation(s)
- Frances J Kellie
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Julius N Wandabwa
- Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
| | - Hatem A Mousa
- University Department of Obstetrics and Gynaecology, Fetal and Maternal Medicine Unit, Leicester Royal Infirmary, Leicester, UK
| | - Andrew D Weeks
- Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
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Kim ML, Hur YM, Ryu H, Lee MJ, Seong SJ, Shin JS. Clinical outcomes of prophylactic compression sutures for treatment of uterine atony during the cesarean delivery of twins. BMC Pregnancy Childbirth 2020; 20:40. [PMID: 31948415 PMCID: PMC6966872 DOI: 10.1186/s12884-019-2716-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 12/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Twin pregnancy has a high risk for developing uterine atony (UA). This study aimed to evaluate efficacy and clinical outcomes of prophylactic compression sutures to treat UA during twin cesarean section (CS). METHODS All patient records of twin deliveries by CS after gestational age of 24 weeks in a large maternity hospital in South Korea between January 2013 and June 2018 were reviewed. Patients with monochorionic monoamniotic twins were excluded from data analysis. In total, 953 women were eligible for data analysis. RESULTS Of the 953 patients, compression sutures were applied to 147 cases with postpartum bleeding that were refractory to uterine massage and uterotonics. Out of the 147, two patients (1.4%) proceeded to additional uterine artery ligation to achieve hemostasis, yielding a success rate of 98.6%. The rate of transfusion after the first 24 h of delivery in the suture group was not significantly different from that in the non-suture group, suggesting that both groups achieved hemostasis at an equal rate after the first 24 h of delivery. The difference in the operation time between the two groups was only 8.5 min. The rate of subsequent pregnancy among the patients who received compression sutures was 44.4%. CONCLUSIONS Overall, our findings suggest that with early and fast implementation of compression sutures, UA can be treated in the setting of twin cesarean delivery without significantly increasing maternal morbidity.
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Affiliation(s)
- Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea
| | - Yoon-Mi Hur
- Department of Education, Institute for Education Research, Mokpo National University, Jeonnam, Republic of Korea
| | - Hyejin Ryu
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea
| | - Min Jin Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea
| | - Joong Sik Shin
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, 06135, Republic of Korea.
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Bernstein SN, Cudemus-Deseda GA, Ortiz VE, Goodman A, Jassar AS. Case 33-2019: A 35-Year-Old Woman with Cardiopulmonary Arrest during Cesarean Section. N Engl J Med 2019; 381:1664-1673. [PMID: 31644848 DOI: 10.1056/nejmcpc1904046] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sarah N Bernstein
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Gaston A Cudemus-Deseda
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Vilma E Ortiz
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Annekathryn Goodman
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Arminder S Jassar
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
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Ryu JM, Choi YS, Bae JY. Bleeding control using intrauterine continuous running suture during cesarean section in pregnant women with placenta previa. Arch Gynecol Obstet 2018; 299:135-139. [PMID: 30386992 DOI: 10.1007/s00404-018-4957-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of intrauterine continuous running suture during cesarean section in pregnant women with placenta previa. METHODS We enrolled 277 women and medical records were retrospectively reviewed. Pregnant women were grouped according to uterine bleeding control methods as follows: Group A, using intrauterine continuous running suture and Group B (control group) using figure-of-eight suture. RESULTS Intrauterine continuous running sutures were used in 104 pregnant women. Mean total blood loss in Group A was significantly less than that in Group B (1332.70 ± 152.92 mL vs 1861.56 ± 157.74 mL, P = 0.029). Mean total transfusion unit of Group A was significantly less than that in Group B (1.74 ± 0.41 vs 3.52 ± 0.75, P = 0.037). CONCLUSIONS Intrauterine continuous running sutures can significantly reduce postpartum blood loss and transfusion units during cesarean section in pregnant women with placenta previa.
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Affiliation(s)
- Jung Min Ryu
- Department of Obstetrics and Gynecology, School of Medicine, Catholic University of Daegu, Gyeongsan, South Korea
| | - Yoon Seok Choi
- Department of Obstetrics and Gynecology, School of Medicine, Catholic University of Daegu, Gyeongsan, South Korea
| | - Jin Young Bae
- Department of Obstetrics and Gynecology, School of Medicine, Catholic University of Daegu, Gyeongsan, South Korea.
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Stein W, Spätling L. Effect of early "quilting" sutures on morbidity in postpartum hemorrhage. Int J Gynaecol Obstet 2018; 144:62-66. [PMID: 30362110 PMCID: PMC7379512 DOI: 10.1002/ijgo.12700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/04/2018] [Accepted: 10/24/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine whether "quilting" sutures are safe and effective in preventing hysterectomy among women with postpartum hemorrhage (PPH) and whether early application might reduce the incidence of transfusion. METHODS Data were reviewed from women treated via quilting sutures after cesarean delivery at a university hospital between 2007 and 2016. Objective and subjective data were collected by analyzing medical records and performing telephone interviews. To observe trends during the study period, data from the first 50% of women treated were compared with those from the second 50%. RESULTS Overall, 26 cesareans with quilting sutures were performed. Two hysterectomies could not be avoided. During 2012-2106, 18 quilting sutures were performed as compared with 8 in 2007-2011, pointing to a more liberal indication. Intensive care was required twice as frequently among the first 13 procedures than among the second 13 procedures (10 vs 5, respectively). A similar observation was made for the use of blood transfusions or clotting activation (9 vs 4, respectively). Three women who desired to have a child subsequently delivered a newborn. CONCLUSION Quilting sutures were found to be a safe and simple technique to prevent hysterectomies in PPH. Morbidity was reduced when the decision to perform sutures was taken early.
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Affiliation(s)
- Werner Stein
- Department of Obstetrics and Gynecology, Klinikum Fulda, Academic Teaching Hospital of the University of Marburg, Fulda, Germany
| | - Ludwig Spätling
- Department of Obstetrics and Gynecology, Klinikum Fulda, Academic Teaching Hospital of the University of Marburg, Fulda, Germany
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Songthamwat S, Songthamwat M. Uterine flexion suture: modified B-Lynch uterine compression suture for the treatment of uterine atony during cesarean section. Int J Womens Health 2018; 10:487-492. [PMID: 30197543 PMCID: PMC6113941 DOI: 10.2147/ijwh.s170460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to report our clinical experience of applying a uterine flexion suture, which was modified from the B-Lynch uterine compression suture, for treating uterine atony during cesarean section. Materials and methods This is a retrospective descriptive study describing the use of a new technique, uterine flexion suture, for treating uterine atony during cesarean section. The study period was from January 2009 to December 2017 at Udonthani Hospital, Udonthani, Thailand. Uterine atony during cesarean section was treated by manual compression, intravenous oxytocin, methylergonovine maleate, and prostaglandins and then was observed for 10-15 minutes before applying a uterine flexion suture in the failed medical treatment cases. The patients were observed for vaginal bleeding, hematometra, and infection after operation. Uterine ultrasound scan results on days 1, 7, and 30 postoperation were also reviewed. Results Fifty-seven patients with uterine atony during cesarean delivery received the uterine flexion suture. The mean age of patients was 27.0 (15-44 years). Thirty-four patients were primipara. The indications for cesarean section were cephalopelvic disproportion in 27 (47.4%) cases, and previous cesarean section in 11 (19.3%) cases. Neither postoperative excessive bleeding nor hysterectomy was observed. There was no hematometra or serious postoperative complication after surgery. The estimated time for uterine flexion suture is only 2-3 minutes and was very easy to perform. Conclusion Uterine flexion suture technique, which was modified from the B-Lynch suture, was inexpensive, quick, and effective in the treatment of atonic postpartum uterus in women undergoing cesarean section.
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Affiliation(s)
- Srisuda Songthamwat
- Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand,
| | - Metha Songthamwat
- Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand,
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Şahin H, Soylu Karapınar O, Şahin EA, Dolapçıoğlu K, Baloğlu A. The effectiveness of the double B-lynch suture as a modification in the treatment of intractable postpartum haemorrhage. J OBSTET GYNAECOL 2018; 38:796-799. [PMID: 29557226 DOI: 10.1080/01443615.2017.1420046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A broader range of more effective compression techniques are needed in the patients who have an intractable postpartum haemorrhage due to uterine atony despite medical treatment and B-Lynch sutures. The aim of this study was to report the outcome of a series of patients with haemorrhage who were managed by double B-Lynch suture. Fourteen patients who were treated in a tertiary hospital between July 2010 and February 2015 were included in the study. The intractable haemorrhage rate was 0.35% over 5 years (14/4000 births). Bleeding was controlled in all the patients with a double B-Lynch suture. The mean age of the patients was 24 ± 3.4 years. The mean estimated blood loss was 1696 ± 272.075 mL, and the mean transfusion rate was 4.2 ± 2.5 units. Pregnancy was observed in five patients at follow up. The double B-Lynch suture seems to be an effective and reliable solution to an intractable postpartum haemorrhage resulting from uterine atony and has no unfavourable impacts on fertility. It should be considered before the use of any aggressive surgical techniques such as a hypogastric artery ligation or a hysterectomy. This the first study to investigate the effectiveness of the double B-Lynch suture, and we showed that the hysterectomy and/or hypogastric artery ligation rate can be decreased by adding a second B-Lynch suture in cases where the medical treatment or a single B-Lynch has failed. Impact statement What is already known on the subject? Uterine atony is the most common cause of a primary postpartum haemorrhage. When a simple massage of the uterus and medication failed to manage this condition, various surgical solutions have been sought, including uterine compression sutures, uterine artery ligation, devascularisation of the uterus, internal iliac artery ligation and, ultimately, a hysterectomy. The B-Lynch suturing technique is particularly useful because of its simplicity of application, life-saving potential, relative safety and capacity for preserving the uterus and subsequent fertility. To-date, this suturing technique, when applied correctly, has been successful with no problems and no apparent complications. However in the cases of when it falls, usually a hysterectomy or a hipogastric artery ligation is preferred. What does this study add? A 'double B-Lynch suture seems to be an effective and reliable method in an intractable postpartum haemorrhage due to a uterine atony and has no unfavourable impact on fertility'. What are the implications of these findings for clinical practice? The double B-Lynch suture seems to be an effective, reliable and technically easy method. With this aspect, it might be considered before any aggressive surgical techniques, such as a hypogastric artery ligation and hysterectomy in selected cases.
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Affiliation(s)
- Hanifi Şahin
- a Department of Gynecologic Oncology , Ankara Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences , Ankara , Turkey
| | - Oya Soylu Karapınar
- b Department of Obstetrics and Gynecology , Mustafa Kemal University Faculty of Medicine , Hatay , Turkey
| | - Eda Adeviye Şahin
- c Dr. Sami Ulus Burak Women's Health Training and Research Hospital, University of Health Sciences , Ankara , Turkey
| | - Kenan Dolapçıoğlu
- b Department of Obstetrics and Gynecology , Mustafa Kemal University Faculty of Medicine , Hatay , Turkey
| | - Ali Baloğlu
- d Izmir Private Gynecology Clinic , Izmir , Turkey
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Seidel V, Braun T, Chekerov R, Nonnenmacher A, Siedentopf JP, Henrich W. Vaginal omentum prolapse due to uterine anterior wall necrosis after prophylactic compression suture for postpartum hemorrhage: case report and review of the literature. CASE REPORTS IN PERINATAL MEDICINE 2017. [DOI: 10.1515/crpm-2016-0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Introduction
Postpartum or peripartum hemorrhage (PPH) is a major cause of maternal death in Western industrialized countries. Fertility preserving second stage interventions following uterotonic drugs include embolization or ligation of relevant arteries, uterine tamponade or compression sutures. Little is known about the complications due to uterine compression sutures. We describe a case report in association with uterine compression sutures and provide a systematic review on necrosis due to compression sutures (CSU).
Data sources
A PubMed database search was done up to October 1, 2016 without any restrictions of publication date or journal, using the following key words: “compression suture” and “postpartum hemorrhage” or “peripartum hemorrhage”. Reported cases were considered eligible when reason for postpartum hemorrhage (PPH), type of compression suture, suture material and type of complication were described.
Results
Among 199 publications a total of 11 reported on uterus necrosis after CSU applied for PPH. B-Lynch and modifications were applied in seven cases, Cho compression sutures in three cases and in one case B-Lynch and Cho techniques were combined. In six cases no additional measures were applied, in two cases vessel ligation, in one case embolization and in one case intrauterine balloon application were applied. In one case of partial necrosis it is not reported if additional measures were applied.
Discussion and conclusion
Uterine compression sutures are a useful method for fertility preserving management of postpartum hemorrhage. The risk of serious complications demands the careful consideration of its use. More research is necessary to improve the technique.
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Benkirane S, Saadi H, Serji B, Mimouni A. Uterine necrosis following a combination of uterine compression sutures and vascular ligation during a postpartum hemorrhage: A case report. Int J Surg Case Rep 2017; 38:5-7. [PMID: 28728102 PMCID: PMC5516088 DOI: 10.1016/j.ijscr.2017.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 07/01/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The Postpartum bleeding is the first cause of maternal mortality in Morocco. It is an obstetrical emergency that requires a fast multimodal management including medical care, interventional procedure and in few cases a salvatory surgery. CLINICAL CASE We report a rare case of uterine necrosis following postpartum hemorrhage, refractory to medical therapy, and which was controlled by a combination of uterine hemostatic techniques and vascular ligation three days after surgery, the patient developed a fever (39°C). At day 3 of postoperative period, the patient developed a fever (39°C) associated with diffuse abdominal pain, diarrhea and non-fetid lochia. At day 5, she presented a state of sepsis. Abdominal and pelvic CT objectified gas bubbles in the uterine myometrium suggestive of necrosis. An exploratory laparotomy was performed. After adhesiolysis, exploration found a complete necrosis of the uterus DISCUSSION: There are many surgical techniques for the management of postpartum bleeding, and hysterectomy remains the reference solution in this context. However, new conservative surgical techniques that are easier to perform and are less aggressive have emerged and are becoming more commonly used. CONCLUSION We emphasize on the importance of choosing surgical techniques that lead to the preservation of uterine vascularization.
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Affiliation(s)
- Saad Benkirane
- Department of Gynecology Obstetrics, CHU Mohammed VI, Oujda, Morocco.
| | - Hanane Saadi
- Department of Gynecology Obstetrics, CHU Mohammed VI, Oujda, Morocco.
| | - Badr Serji
- Department of Oncologie, CHU Mohammed VI, Oujda, Morocco.
| | - Ahmed Mimouni
- Department of Gynecology Obstetrics, CHU Mohammed VI, Oujda, Morocco.
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Revert M, Cottenet J, Raynal P, Cibot E, Quantin C, Rozenberg P. Intrauterine balloon tamponade for management of severe postpartum haemorrhage in a perinatal network: a prospective cohort study. BJOG 2016; 124:1255-1262. [PMID: 27781401 DOI: 10.1111/1471-0528.14382] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of intrauterine balloon tamponade (IUBT) for management of severe postpartum haemorrhage (PPH). To identify the factors predicting IUBT failure. DESIGN Prospective cohort study. SETTING Ten maternity units in a perinatal network. POPULATION Women treated by IUBT from July 2010 to March 2013. METHODS The global IUBT success rate was expressed as the number of women with severe PPH who were successfully treated by IUBT divided by the total number treated by IUBT. IUBT failure was defined as the need for arterial embolisation or surgery. Logistic regression analysis was used to estimate factors predicting IUBT failure. MAIN OUTCOME MEASURES Global IUBT success rate. Factors associated with IUBT failure. RESULTS Intrauterine balloon tamponade was attempted in 226 women: 171 after vaginal delivery (VD) (75.7%) and 55 during or after caesarean delivery (CD) (24.3%). The global success rate was 83.2% (188/226) and was significantly higher after VD (152/171, 88.9%) than CD (36/55, 65.5%, P < 0.01). The percentage of CD was significantly higher in the failure group (50.0 versus 19.1%, P < 0.01), as was mean (SD) estimated blood loss before IUBT: 1508 ± 675 ml versus 1064 ± 476, P < 0.01. Coagulopathy was significantly more frequent in the failure group (50.0% versus 17.2%, P < 0.01). CD [Odds ratio (OR) 3.5; 95% CI 1.6-7.6], estimated blood loss before IUBT (OR 3.2; 95% CI 1.5-6.8) and coagulopathy (OR 5.6; 95% CI 2.5-13.0) were predictive of IUBT failure. CONCLUSION Intrauterine balloon tamponade is an effective method for treating severe PPH. Early balloon deployment before the development of coagulopathy increases its success rate. TWEETABLE ABSTRACT Intrauterine balloon tamponade is effective for achieving haemostasis in intractable postpartum haemorrhages.
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Affiliation(s)
- M Revert
- EA 7285, Versailles Saint Quentin University, Versailles, France
| | - J Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France
| | - P Raynal
- Department of Obstetrics and Gynaecology, André Mignot Hospital, Versailles, France
| | - E Cibot
- Department of Obstetrics and Gynaecology, Poissy Saint-Germain Hospital, Poissy, France
| | - C Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France.,Inserm, CIC 1432, Dijon, France.,Dijon University Hospital, Clinical Investigation Center, Dijon, France.,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Villejuif, France
| | - P Rozenberg
- EA 7285, Versailles Saint Quentin University, Versailles, France.,Department of Obstetrics and Gynaecology, Poissy Saint-Germain Hospital, Poissy, France
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25
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Three cornerstones of uterine compression sutures: simplicity, safety and efficacy. Arch Gynecol Obstet 2015; 292:949-52. [PMID: 26306987 DOI: 10.1007/s00404-015-3873-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
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26
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Uterus Wrapping: A Novel Concept in the Management of Uterine Atony during Cesarean Delivery. Case Rep Obstet Gynecol 2015; 2015:195696. [PMID: 26380132 PMCID: PMC4563056 DOI: 10.1155/2015/195696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/16/2015] [Indexed: 11/17/2022] Open
Abstract
Uterine atony during cesarean delivery is a serious cause of maternal morbidity and mortality. Management strategies include medical treatment with uterotonic agents, manual compression of the uterus, and interventional or surgical procedures. A novel technique to compress the uterus by wrapping it with an elastic bandage and its outcome in 3 cases of uterine atony during cesarean section are presented. Our novel method of intermittent wrapping of the uterus during cesarean delivery seems to be a successful additional approach in the management of uterine atony during cesarean delivery and may be an alternative treatment option to other compressing procedures in order to avoid high blood loss and last but not least postpartum hysterectomy.
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Haumonté JB, Sentilhes L, Macé P, Cravello L, Boubli L, d’Ercole C. Prise en charge chirurgicale d’une hémorragie du post-partum. ACTA ACUST UNITED AC 2014; 43:1083-103. [DOI: 10.1016/j.jgyn.2014.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Jamard A, Turck M, Chéret-Benoist A, Dreyfus M, Benoist G. [Risk of uterine synechiae following uterine compression sutures during postpartum haemorrhage]. ACTA ACUST UNITED AC 2014; 42:681-5. [PMID: 24996879 DOI: 10.1016/j.gyobfe.2014.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Uterine compression sutures are highly successful conservative surgical techniques used to treat severe postpartum haemorrhage. These methods can induce subsequent uterine synechiae. To determine this risk of synechiae after conservative uterine compression sutures, which may induce further fertility problems. PATIENTS AND METHODS We retrospectively reviewed the medical and pathological records of the patients who underwent uterine compression sutures for severe postpartum haemorrhage between January 2003 and March 2013 in a French University Hospital. The Cho's, the B-Lynch's and the Hayman's techniques have been used. The results of the hysteroscopies were detailed. RESULTS Among the 25 patients included, the B-Lynch or the Hayman's techniques have been used in 13 cases (52%). The Cho's technique has been performed alone for 5 patients (20%) and both techniques have been practiced in 7 situations (28%). In 17 cases (68%), some vascular sutures have been associated and, for 7 patients (28%), a vascular embolisation had been performed before the uterine compressive sutures. Only 19 patients underwent a diagnostic hysteroscopy and among them 13 had a normal uterine cavity (68%), 3 of them had uterine synechiae (16%) and 3 had placental retention (16%). Synechiae and retention have all been successfully removed by operative hysteroscopy. DISCUSSION AND CONCLUSION The compressive techniques can induce uterine synechiae, which may impair subsequent fertility.
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Affiliation(s)
- A Jamard
- Département d'obstétrique, de gynécologie et de médecine de la reproduction, pôle femmes-enfants, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Caen - Basse-Normandie, 14000 Caen, France
| | - M Turck
- Département d'obstétrique, de gynécologie et de médecine de la reproduction, pôle femmes-enfants, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Chéret-Benoist
- Département d'obstétrique, de gynécologie et de médecine de la reproduction, pôle femmes-enfants, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - M Dreyfus
- Département d'obstétrique, de gynécologie et de médecine de la reproduction, pôle femmes-enfants, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Caen - Basse-Normandie, 14000 Caen, France
| | - G Benoist
- Département d'obstétrique, de gynécologie et de médecine de la reproduction, pôle femmes-enfants, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Caen - Basse-Normandie, 14000 Caen, France.
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Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2014; 2014:CD003249. [PMID: 24523225 PMCID: PMC6483801 DOI: 10.1002/14651858.cd003249.pub3] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Primary postpartum haemorrhage (PPH) is one of the top five causes of maternal mortality in both developed and developing countries. OBJECTIVES To assess the effectiveness and safety of any intervention used for the treatment of primary PPH. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2013). SELECTION CRITERIA Randomised controlled trials comparing any interventions for the treatment of primary PPH. DATA COLLECTION AND ANALYSIS We assessed studies for eligibility and quality and extracted data independently. We contacted authors of the included studies to request more information. MAIN RESULTS Ten randomised clinical trials (RCTs) with a total of 4052 participants fulfilled our inclusion criteria and were included in this review.Four RCTs (1881 participants) compared misoprostol with placebo given in addition to conventional uterotonics. Adjunctive use of misoprostol (in the dose of 600 to 1000 mcg) with simultaneous administration of additional uterotonics did not provide additional benefit for our primary outcomes including maternal mortality (risk ratio (RR) 6.16, 95% confidence interval (CI) 0.75 to 50.85), serious maternal morbidity (RR 0.34, 95% CI 0.01 to 8.31), admission to intensive care (RR 0.79, 95% CI 0.30 to 2.11) or hysterectomy (RR 0.93, 95% CI 0.16 to 5.41). Two RCTs (1787 participants) compared 800 mcg sublingual misoprostol versus oxytocin infusion as primary PPH treatment; one trial included women who had received prophylactic uterotonics, and the other did not. Primary outcomes did not differ between the two groups, although women given sublingual misoprostol were more likely to have additional blood loss of at least 1000 mL (RR 2.65, 95% CI 1.04 to 6.75). Misoprostol was associated with a significant increase in vomiting and shivering.Two trials attempted to test the effectiveness of estrogen and tranexamic acid, respectively, but were too small for any meaningful comparisons of pre-specified outcomes.One study compared lower segment compression but was too small to assess impact on primary outcomes.We did not identify any trials evaluating surgical techniques or radiological interventions for women with primary PPH unresponsive to uterotonics and/or haemostatics. AUTHORS' CONCLUSIONS Clinical trials included in the current review were not adequately powered to assess impact on the primary outcome measures. Compared with misoprostol, oxytocin infusion is more effective and causes fewer side effects when used as first-line therapy for the treatment of primary PPH. When used after prophylactic uterotonics, misoprostol and oxytocin infusion worked similarly. The review suggests that among women who received oxytocin for the treatment of primary PPH, adjunctive use of misoprostol confers no added benefit.The role of tranexamic acid and compression methods requires further evaluation. Furthermore, future studies should focus on the best way to treat women who fail to respond to uterotonic therapy.
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Affiliation(s)
- Hatem A Mousa
- Leicester Royal InfirmaryUniversity Department of Obstetrics and Gynaecology, Fetal and Maternal Medicine UnitInfirmary SquareLeicesterUKLE1 5WW
| | - Jennifer Blum
- Gynuity Health Projects15 East 26th St, Suite 801New YorkUSA10010
| | - Ghada Abou El Senoun
- Queen's Medical Centre, Nottingham University HospitalDepartment of Obstetrics and GynaecologyDerby RoadNottinghamNottinghamshireUKNG7 2UH
| | - Haleema Shakur
- London School of Hygiene & Tropical MedicineClinical Trials UnitKeppel StreetLondonUKWC1E 7HT
| | - Zarko Alfirevic
- The University of LiverpoolDepartment of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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El-Refaeey AA, Gibreel A, Fawzy M. Novel modification of B-Lynch uterine compression sutures for management of atonic postpartum hemorrhage: VV uterine compression sutures. J Obstet Gynaecol Res 2014; 40:387-91. [PMID: 24118407 DOI: 10.1111/jog.12166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/23/2013] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to demonstrate a novel modification of uterine compression sutures for use in women with primary postpartum hemorrhage and to evaluate its effectiveness. MATERIAL AND METHODS This was a prospective observational study. Nineteen patients with atonic postpartum hemorrhage were subjected to the novel VV uterine compression sutures at the time of cesarean delivery. RESULTS The procedure was successful in 18 out of 19 women (94.7%) in controlling the bleeding and preserving the patient's uterus. Only one patient required supravaginal hysterectomy. CONCLUSIONS VV compression sutures comprise an easy, safe and effective procedure that can be applied in cases of atonic postpartum hemorrhage.
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Affiliation(s)
- Abdel-Aziz El-Refaeey
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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31
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Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
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32
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Outcomes of Subsequent Pregnancies After Uterine Compression Sutures for Postpartum Hemorrhage. Obstet Gynecol 2013; 122:565-70. [DOI: 10.1097/aog.0b013e31829e3b1d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Gizzo S, Saccardi C, Patrelli TS, Di Gangi S, Breda E, Fagherazzi S, Noventa M, D'Antona D, Nardelli GB. Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature. Fertil Steril 2013; 99:2097-107. [PMID: 23498891 DOI: 10.1016/j.fertnstert.2013.02.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 02/08/2013] [Accepted: 02/08/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the most appropriate surgical technique for optimizing hemostasis and preservation of subsequent fertility after postpartum hemorrhage (PPH). DESIGN Systematic review of the literature. SETTING Not applicable. PATIENT(S) None. INTERVENTION(S) Review of MEDLINE, EMBASE, ScienceDirect, and the Cochrane Library. MAIN OUTCOME MEASURE(S) Comparison of the effectiveness of conservative surgical techniques, separately or together, with respect to success rate (ability to stop bleeding and preserve the uterus), fertility rate (subsequent pregnancies or the return of regular menstrual cycles), complication rate of the procedure, and the outcomes of subsequent pregnancies in terms of type of delivery and eventual delivery complications. RESULT(S) Compressive sutures and vessel embolization may be considered life-saving procedures by achieving the best hemostatic efficacy. Data on restoration of menses and pregnancy rates after these procedures are limited by short-term follow-up and by the paucity of studies, especially for vascular ligation. CONCLUSION(S) Pelvic vessel embolization and compressive sutures are associated with high rates of restoration of regular menses and successive pregnancies, even if the former is burdened by an increased rate of placental disorders and fetal growth restriction and the latter by an increased risk of cesarean deliveries and PPH recurrence. Randomized trials would be desirable to define the best management of PPH.
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Affiliation(s)
- Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy.
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34
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Matsubara S, Yano H, Ohkuchi A, Kuwata T, Usui R, Suzuki M. Uterine compression sutures for postpartum hemorrhage: an overview. Acta Obstet Gynecol Scand 2013; 92:378-85. [DOI: 10.1111/aogs.12077] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi; Japan
| | - Hitoshi Yano
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi; Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi; Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi; Japan
| | - Rie Usui
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi; Japan
| | - Mitsuaki Suzuki
- Department of Obstetrics and Gynecology; Jichi Medical University; Tochigi; Japan
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Laas E, Bui C, Popowski T, Mbaku OM, Rozenberg P. Trends in the rate of invasive procedures after the addition of the intrauterine tamponade test to a protocol for management of severe postpartum hemorrhage. Am J Obstet Gynecol 2012; 207:281.e1-7. [PMID: 23021688 DOI: 10.1016/j.ajog.2012.08.028] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/30/2012] [Accepted: 08/14/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate changes in invasive procedure rates after the addition of intrauterine balloon tamponade as an initial second-line therapy to our protocol for the management of severe postpartum hemorrhage. STUDY DESIGN We compared the outcomes of all patients with postpartum hemorrhage that was unresponsive to prostaglandin during 2 equal periods, before (first period) and after (second period) the introduction of a balloon tamponade protocol. RESULTS During the second period, 43 women had uterine tamponade with a Bakri balloon as their initial second-line therapy (after vaginal delivery, 31; after caesarean delivery, 12). The global success rate was 86% (37/43 women). Among patients who delivered vaginally, the rates of arterial embolization (8.2% vs 2.3% in the first and second period; P = .006; odds ratio, 0.26; 95% confidence interval, 0.09-0.72) and conservative surgical procedures (5.1% vs 1.4%, in the first and second period; P = .029; odds ratio, 0.26; 95% confidence interval, 0.07-0.95) were significantly lower after the uterine tamponade test was added to our protocol. CONCLUSION Intrauterine balloon tamponade is an attractive adjunctive strategy for the achievement of hemostasis in intractable hemorrhages and prevention of the need for invasive procedures.
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Akbayir O, Corbacioglu Esmer A, Cilesiz Goksedef P, Ekiz A, Akca A, Guraslan B, Akagunduz G. Single square hemostatic suture for postpartum hemorrhage secondary to uterine atony. Arch Gynecol Obstet 2012; 287:25-9. [DOI: 10.1007/s00404-012-2509-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
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Rath W, Hackethal A, Bohlmann MK. Second-line treatment of postpartum haemorrhage (PPH). Arch Gynecol Obstet 2012; 286:549-61. [DOI: 10.1007/s00404-012-2329-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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38
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"Quilting" sutures to prevent hysterectomy in patients with postpartum hemorrhage. Int J Gynaecol Obstet 2012; 117:291. [PMID: 22424662 DOI: 10.1016/j.ijgo.2012.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 02/16/2012] [Indexed: 11/21/2022]
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Laparoscopic bipolar coagulation of hypogastric artery in postpartum haemorrhage: a case report. Case Rep Obstet Gynecol 2011; 2011:250325. [PMID: 22567499 PMCID: PMC3335507 DOI: 10.1155/2011/250325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 07/06/2011] [Indexed: 01/31/2023] Open
Abstract
Background. Postpartum haemorrhage (PPH) is a
significant contributor to worldwide maternal morbidity and mortality.
When PPH continues despite aggressive medical treatment, early
consideration should be given to surgical intervention. Various
surgical interventions may be used but conservative interventions are
recommended primarily. Case. This case report
describes laparoscopic coagulation of hypogastric artery technique in
a patient with PPH. Conclusions. Laparoscopic
ligature of the hypogastric artery for PPH treatment can be a valid
alternative to laparotomy in patients with vaginal delivery.
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40
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Al Riyami N, Hui D, Herer E, Nevo O. Uterine compression sutures as an effective treatment for postpartum hemorrhage: case series. AJP Rep 2011; 1:47-52. [PMID: 23705085 PMCID: PMC3653545 DOI: 10.1055/s-0031-1280570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 01/22/2011] [Indexed: 11/17/2022] Open
Abstract
We evaluated the role of uterine compression sutures as a conservative treatment for postpartum hemorrhage (PPH) after failed medical treatment. We retrospectively reviewed the charts of all patients who delivered between 2003 and 2009 at a single tertiary care center and who underwent uterine compression sutures for PPH. Twelve women had uterine compression sutures for PPH. The mean age of the patients was 36.3 ± 5.2 years. The mean gestational age at delivery was 37.7 ± 2.0 weeks, and the average estimated blood loss was 2.1 ± 1.1 L. The mean procedure time to perform the uterine compression sutures was 9.3 ± 2.8 minutes. The success rate of compression sutures was 92% with only one failure resulting in a hysterectomy. Uterine compression sutures are an effective method for the treatment of PPH, thus avoiding hysterectomy and preserving potential fertility.
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Affiliation(s)
- Nihal Al Riyami
- Department of Obstetrics and Gynecology, Sunnybrook, Health Sciences Centre, University of Toronto, Toronto, Canada ; Division of Maternal-Fetal Medicine, Sunnybrook, Health Sciences Centre, University of Toronto, Toronto, Canada
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Palacios-Jaraquemada JM. Efficacy of surgical techniques to control obstetric hemorrhage: analysis of 539 cases. Acta Obstet Gynecol Scand 2011; 90:1036-42. [PMID: 21564024 DOI: 10.1111/j.1600-0412.2011.01176.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze the efficacy of surgical techniques to stop excessive obstetric bleeding. DESIGN Retrospective follow up. SETTING Center for Medical Education and Clinical Research and a total of twelve hospitals in Buenos Aires. POPULATION Five hundred and thirty-nine consecutive patients were included: 361 had placenta accreta-percreta, 114 uterine atony, 19 cervical scar pregnancy, 21 placenta previa and 24 uterine-cervical-vaginal tears. Three hundred and forty-seven women had surgery, of whom 192 were emergencies. METHODS The surgical techniques included selective arterial ligation and compression procedures. The effectiveness of the techniques was assessed by cessation of bleeding according to source. Follow up included hysteroscopy of 100 patients and magnetic resonance imaging of 341 patients. MAIN OUTCOME MEASURES Strong association between topographical uterine irrigation areas and surgical hemostatic technique was established. RESULTS Hemorrhage stopped following arterial ligation or compression sutures in 499 women, but hysterectomy was needed in 40. In cervical, lower segment and upper vaginal bleeding, Cho's compression sutures proved to be an efficient and simple procedure. Most surgical hemostatic failures that led to hysterectomy occurred in women with severe hemodynamic deterioration and coagulopathy. Two women died due to multiorgan failure. After surgery, 116 successful pregnancies were reported. CONCLUSIONS Bilateral occlusions of the uterine artery or its branches were useful procedures to stop upper uterine bleeding. Square sutures were a simple and effective procedure to control lower genital tract bleeding.
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AMORIM-COSTA CÉLIA, MOTA RAQUEL, REBELO CLAUDIO, SILVA PEDROTIAGO. Uterine compression sutures for postpartum hemorrhage: is routine postoperative cavity evaluation needed? Acta Obstet Gynecol Scand 2011; 90:701-6. [DOI: 10.1111/j.1600-0412.2011.01137.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Poujade O, Grossetti A, Mougel L, Ceccaldi PF, Ducarme G, Luton D. Risk of synechiae following uterine compression sutures in the management of major postpartum haemorrhage. BJOG 2010; 118:433-9. [DOI: 10.1111/j.1471-0528.2010.02817.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fotopoulou C, Dudenhausen JW. Uterine compression sutures for preserving fertility in severe postpartum haemorrhage: An overview 13 years after the first description. J OBSTET GYNAECOL 2010; 30:339-49. [DOI: 10.3109/01443611003650233] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- C. Fotopoulou
- Department of Gynecology and Obstetrics, Charité, Campus Virchow Clinic, University Hospital, Berlin, Germany
| | - J. W. Dudenhausen
- Department of Gynecology and Obstetrics, Charité, Campus Virchow Clinic, University Hospital, Berlin, Germany
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Mallappa Saroja CS, Nankani A, El-Hamamy E. Uterine compression sutures, an update: review of efficacy, safety and complications of B-Lynch suture and other uterine compression techniques for postpartum haemorrhage. Arch Gynecol Obstet 2009; 281:581-8. [PMID: 19834719 DOI: 10.1007/s00404-009-1249-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 09/25/2009] [Indexed: 11/29/2022]
Abstract
Since the advent of uterine compression suture by B-Lynch, numerous techniques have been advocated. We aim to discuss these various techniques with respect to their efficacy, safety, complications, complexity of the technique itself, future fertility and menstrual periods. Since no randomized controlled trials are available, the conclusions are based on weak data derived from observational studies and case series. A success rate of 91.7% has been reported for various uterine compression sutures. There are concerns regarding closure of uterine cavity and blood entrapment resulting in infection, pyometra and adhesions as the uterus will be transfixed from front to back in some of the suturing techniques. Long-term follow-up regarding fertility of patients who had uterine compression sutures is urgently needed. Data on menstrual periods after uterine compression sutures is limited. Our review is limited in nature due to lack of consistent data on many important outcomes and also preclinical variables.
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Matsubara S, Yano H, Taneichi A, Suzuki M. Uterine compression suture against impending recurrence of uterine inversion immediately after laparotomy repositioning. J Obstet Gynaecol Res 2009; 35:819-23. [DOI: 10.1111/j.1447-0756.2008.01011.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Obstetric hemorrhage is often a sudden, life-threatening event. Successful management hinges on both preoperative preparation if hemorrhage is anticipated as well as knowledge of interventions. Uterine-sparing techniques, such as aggressive and early use of uterotonics, balloon tamponade, uterine compression sutures, arterial ligation, and selective arterial embolization, may be used to control hemorrhage. If these techniques are not adequate, the decision must be made to proceed with hysterectomy. The type of hysterectomy (subtotal vs. total) must be individualized to each patient. Hemostatic agents may be particularly useful in patients who have excessive blood loss from raw tissue surfaces.
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Affiliation(s)
- Monjri Shah
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
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48
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Resultados en relación con la prevención y el tratamiento actual de las hemorragias obstétricas graves secundarias a atonías uterinas y acretismos placentarios. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2009. [DOI: 10.1016/j.gine.2008.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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49
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Henrich W, Surbek D, Kainer F, Grottke O, Hopp H, Kiesewetter H, Koscielny J, Maul H, Schlembach D, von Tempelhoff GF, Rath W. Diagnosis and treatment of peripartum bleeding. J Perinat Med 2009; 36:467-78. [PMID: 18783309 DOI: 10.1515/jpm.2008.093] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Severe peripartum hemorrhage (PPH) contributes to maternal morbidity and mortality and is one of the most frequent emergencies in obstetrics, occurring at a prevalence of 0.5-5.0%. Detection of antepartum risk factors is essential in order to implement preventive measures. Proper training of obstetric staff and publication of recommendations and guidelines can effectively reduce the frequency of PPH and its resulting morbidity and mortality. Therefore, an interdisciplinary expert committee was formed, with members from Germany, Austria, and Switzerland, to summarize recent scientific findings. An up-to-date presentation of the importance of embolization and of the diagnosis of coagulopathy in PPH is provided. Furthermore, the committee recommends changes in the management of PPH including new surgical options and the off-label use of recombinant factor VIIa.
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Affiliation(s)
- Wolfgang Henrich
- Department of Obstetrics, Charité-University Medicine Berlin, 13353 Berlin, Germany.
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Kainer F, Hasbargen U. Emergencies associated with pregnancy and delivery: peripartum hemorrhage. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:629-38. [PMID: 19471625 DOI: 10.3238/arztebl.2008.0629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 07/14/2008] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Peripartum hemorrhage is one of the leading causes of maternal death worldwide (25%). METHODS Selective literature review, including international guidelines, for assessment of the causes and optimal management of this condition. RESULTS The major causes of hemorrhage are uterine atony, placenta previa, and abruptio placentae. The diagnosis of hemorrhage is suspected from its clinical manifestations and confirmed by ultrasonography. In placenta previa, the placenta is implanted in the lower uterine segment and may cover the internal cervical os. Placenta previa is more common in older and multiparous mothers, as well as in mothers who have previously undergone a cesarean section. Placental abruption is defined as separation of the placenta from the uterine wall before delivery of the infant. The risk factors for this condition include preeclampsia, advanced maternal age, and trauma. When it presents with manifestations of acute blood loss, premature abruption placentae must be diagnosed rapidly and treated without delay to save the life of the mother and child. A rare, but highly lethal, cause of bleeding is amniotic fluid embolism, which manifests itself with sudden and unexplained peripartum respiratory distress and cardiovascular collapse. Amniotic fluid embolism is associated with high fetal and maternal mortality (20% and 60% to 80%, respectively) even when it is optimally treated. DISCUSSION Peripartum hemorrhage is an important source of maternal and fetal morbidity and mortality. The prognosis for both mother and child can be markedly improved if the risk factors for hemorrhage are recognized and the problem is treated rapidly and appropriately when it arises.
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