Postpartum Hemorrhage

Abstract

Interventional radiologists are often called for emergent control of abnormal uterine bleeding. Bleeding, even heavy bleeding as a result of uterine fibroids is not a common emergent procedure; instead, pregnancy and pregnancy related conditions, trauma and malignancy associated with bleeding can be the source of many interventional radiology on call events or procedures. Postpartum hemorrhage (PPH) is the most common cause, and is defined as blood loss of 500mL after vaginal delivery or 1000mL after cesarean section. Several authors have suggested a simpler definition of any amount of blood loss that creates hemodynamic instability in the mother. Regardless, PPH can be a life-threatening emergency and is a leading cause of maternal mortality requiring prompt action. Primary PPH is bleeding within the first 24 hour of delivery and secondary PPH is hemorrhage that occurs more than 24 hour after delivery. In addition to death, other serious morbidity resulting from postpartum bleeding includes shock, adult respiratory distress syndrome, coagulopathy, and loss of fertility due to hysterectomy. Transcatheter uterine artery embolization was first introduced as a treatment for PPH in 1979. It is a nonsurgical, minimally invasive, extremely safe and effective treatment for controlling excessive bleeding of the female reproductive track usually after conservative measures have failed, yet somewhat underused. Referring providers have limited awareness of the procedure. In hospitals where interventional radiologists have the experience and technical expertise to perform pelvic arteriography and embolization, this therapeutic option can play a pivotal role in the management of emergent obstetric hemorrhage.

Secondary Postpartum Hemorrhage after Cesarean Delivery: A Case Report

“…Secondary postpartum hemorrhage and delayed bleeding can occur after dehiscence of uterus incision after cesarean section. In most cases, this condition results in severe bleeding in the second or third week after delivery, which often requires subtotal hysterectomy to control bleeding (8). We hereby report a case of delayed postpartum hemorrhage after cesarean delivery.…”

“…Secondary hemorrhage after cesarean section is rare and occurs in about 1 per 365 cases (7). Secondary postpartum hemorrhage is characterized by severe bleeding, shock or anemia; therefore, proper diagnosis and management of bleeding is crucial (8). Depending on the severity and extent of bleeding, pharmacological, mechanical, non-surgical or surgical interventions may be applicable (9).…”

Complications of Cesarean Operation

“…In developing countries, obstetric hemorrhage alternates the first and second position with preeclampsia as a cause of maternal death, and the World Health Organization accepts a rate of 10% worldwide in all births with live fetus [3,4,[14][15][16][17][18][19][20][21].…”

“…It must be borne in mind that the indication of cesarean section "per se" implies a pathological background disorder such as the anomalous insertion of the placenta, maternal hypertension, the infection, prolonged labor, uterine overdistention, and so on, which are factors that significantly alter the vascular network and uterine contractility, increasing the bleeding caused by the same vascular damage during the surgical act which increases when there is difficulty in extracting the fetus since it can easily tear the hysterotomy causing greater vascular damage [3,4,[14][15][16][17][18][19][20][21].…”

Effect of Bakri Balloon on Managing Postpartum Hemorrhage: A Case Series

“…Primary PPH that appears as bleeding during the first 24 hours after delivery; and 2. Secondary PPH, developed 24 hours and up to 6 weeks after postpartum [1]. PPH control depends on its cause.…”