Post-partum hemorrhage: can it be prevented by assisting the natural physiological process?

Abstract

Background. Anteversion of the uterus is essential for the abdominal pregnant uterus growth and for the uterine contraction during labor and post-partum period. The role of the round ligaments is not yet completely understood, but certainly do have a coherent synergistic role with that of the neo-myometrium. The uterine contraction depends not only by the uterine muscle fibers, but also by the integrated pelvic myofascial system, connecting the uterine body to the round ligaments, to the ileo-psoas muscles and to the abdominal wall. In view of these functional anatomy reflections, it is possible to understand the procedures used in our management of postpartum hemorrhage and in our study. Materials and methods. We have a retrospective observational study of a population of 5927 women who delivered by Cesarean Section or vaginal labor between 2014 and 2018, after the 34th gestational week. Of these, 173 women with risk factors for postpartum hemorrhage (PPH) or with mild PPH were treated with a non-invasive method consisting of an abdominal band for uterine compression/anteversion, in combination with standard drug or surgical therapy. Results. We had only one peripartum hysterectomy on 5927 birth 0.016/1000 (Italy-ItOSS 1.08/1000, Regno Unit UKOSS-NethOSS-Nord Europa NOSS 0.3-0.4/1000). Five women received 4 or more blood transfusions on 5927 delivers (0.85/1000). Conclusions. The non-invasive uterine compression technique reduced the incidence of PPH in high-risk women and prevented maternal morbidity and mortality. SOMMARIOBackground. L'antiversione uterina è essenziale per l'espansione dell'utero gravidico nell'addome e per le contrazioni durante il travaglio e nel post-partum. Il ruolo dei legamenti rotondi non è ancora del tutto compreso, ma sicuramente ha un ruolo coerente e sinergico con quello del neo-miometrio. La contrazione uterina dipende non solo dalle fibre muscolari uterine, ma dal sistema integrato miofasciale pelvico, che collega il corpo uterino ai legamenti rotondi, ai muscoli ileo-psoas e ai muscoli della parete addominale. In considerazione di queste riflessioni anatomico-funzionali, è possibile comprendere le procedure che abbiamo utilizzato nella gestione dell'emorragia postpartum e nel nostro studio. Materiali e metodi. Si tratta di uno studio retrospettivo osservazionale su una popolazione di 5927 donne che hanno partorito con taglio cesareo o per via vaginale in un periodo compreso tra il 2014 e il 2018, dopo la 34esima settimana gestazionale. Di queste, 173 donne con fattori di rischio per emorragia postpartum (EPP) o con lieve EPP sono state trattate con un metodo non invasivo costituito da una fascia addominale per la compressione/antiversione uterina, in combinazione con farmaci standard o terapia chirurgica. Risultati. Abbiamo avuto solo un'isterectomia peripartum su 5927 nascite. 0.016/1000 (Italia-ItOSS 1,08/1000, Unità Regno UKOSS-NethOSS-Nord Europa NOSS 0,3-0,4/1000). Cinque donne hanno ricevuto 4 o più trasfusioni di sangue su 5927 parti (0,85/1000). Conclusioni. La tecnica di...

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