The surgical management of postpartum haemorrhage

Abstract

This review summarizes the options available for the management of postpartum haemorrhage when ecbolic agents have failed to control the bleeding and an obvious rectifiable problem such as retained placental fragments, lower genital tract trauma, uterine inversion or uterine rupture have been excluded or dealt with. The review covers the range of surgical options but gives an in-depth explanation of the more recent developments such as uterine brace sutures, the use of the Sengstaken-Blakemore tube and embolization procedures.

Balloon tamponade in the management of postpartum haemorrhage: a review

“…These include internal iliac artery ligation, uterine compression sutures and peripartum hysterectomy to control the life-threatening haemorrhage. [9][10][11] Recently, uterine balloon tamponade has been added to this armamentarium in the management of PPH. 7,[12][13][14] The purpose of this paper was to review the various uterine tamponade technologies currently available for the management of PPH.…”

Successful Treatment of Post-Cesarean Hemorrhage Related to Placenta Praevia Using an Intrauterine Balloon

“…If conservative measures fail, however, it is often necessary to intervene surgically with uterine or internal iliac ligation, uterine compression sutures, or hysterectomy. Over the last few years a number of new and simpler techniques (which also preserve fertility) have been developed in the attempt to avoid major surgical procedures [5] . While a variety of surgical techniques have been proposed to avoid hysterectomy, a suitable conservative technique is still lacking in the literature and all the advantages shown by the proposed options are counterbalanced by some risks [8] .…”

“…Surgical measures proposed to avoid bleeding and to allow hemostasis with suture techniques of the placental site must face the problem that, in cases of placenta praevia or low-lying placenta, bleeding may originate below the uterine incision and the most inferior part of the lower segment [5] . The large sinuses responsible for the bleeding must be undersewn; the challenge in undersuturing may be the extreme thinness of the lower segment, which may tear every time suturing is attempted from within the cavity.…”

“…Finally, reports are accumulating suggesting that methods of uterine tamponade are effective, avoid hysterectomy in frequently unstable patients and preserve fertility [5] . The theoretical principle is based on the premise that the tamponade produces a vascular compression of the bleeding surface, allowing hemostasis while waiting for the normal defi nitive clotting mechanisms.…”

“…

unstable patients and associated with elevated maternal morbidity and compromised fertility [4] , conservative measures to control hemorrhage are recently reported in order to avoid cesarean hysterectomy [5] .We report our positive experience in controlling severe postpartum hemorrhage after cesarean section performed for placenta praevia by using an infl ated intrauterine balloon thus avoiding major surgery.

Case 1A 36-year-old woman, gravida 2, para 1, was admitted at 30 weeks' gestation to our Perinatal Unit for threatened preterm labor. Previously, during the current pregnancy, an ultrasound scan had been performed at 23 weeks' gestation showing a low inserted placenta.

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