Control of persistent primary postpartum haemorrhage due to uterine atony with intravenous prostaglandin E2. Case report

The boldest procedure possible for checking the bleeding--a new look at an old operation, and a series of 13 cases from an Australian hospital

Ligation of the internal iliac (hypogastric) arteries in cases of massive obstetric and gynaecological haemorrhage can be a life-saving operation, but it has never been widely practised in the British gynaecological tradition. There may be historical reasons for this. A series of 13 cases is presented from one Australian hospital over a 5-year period, and a very low rate of Caesarean hysterectomy is demonstrated. A wider knowledge of the technique is recommended. Alternative methods of management, including angiographic embolization and the use of prostaglandins are discussed.

Severe hypotension due to intramyometrial injection of prostaglandin E2

Treatment of postpartum haemorrhage because of uterine atony with intramyometrial prostaglandin E2 1 mg, in an anaesthetised patient resulted in life-threatening hypotension. Anaesthetists should be aware of the potential cardiovascular side effects of prostaglandins.

Management of severe postpartum hemorrhage by intrauterine irrigation with prostaglandin E2

Continuous intrauterine irrigation with minute amounts of prostaglandin E2 was used in 22 patients with severe postpartum hemorrhage unmanageable by conventional therapy. Twenty-one women were treated because of uterine atonic hemorrhage and one because of late postpartum hemorrhage from subinvolution. A quick tetanic contraction of the uterine muscle with dramatic and sustained hemostasis was achieved in all patients. The therapeutic response was continuous and uninterrupted regardless of the predisposing factors for the hemorrhage or the hemodynamic condition of the patients. No side effects were observed.

Choice of oxytocic preparation for routine use in the management of the third stage of labour: an overview of the evidence from controlled trials

Prophylactic use of oxytocics reduces the risk of postpartum haemorrhage by about 40%. The analysis presented in this paper assesses which oxytocic preparation is associated with the least risk of postpartum haemorrhage and examines the relative effects of different preparations on the length of the third stage, the risk of manual removal of the placenta, blood pressure and other side-effects. A mixture of oxytocin and ergometrine (Syntometrine) appears to be the safest and most effective prophylactic of the alternatives which have been compared, but the quality of the evidence is not satisfactory. There is scope for a randomized comparison of Syntometrine with oxytocin to obtain unbiased and more precise estimates of their relative effects on postpartum haemorrhage, blood pressure and unpleasant side-effects.