ABSTRACT
Obstetrical hemorrhage is one of the deadly triad, along with hypertensive disorder in pregnancy and infection. Postpartum hemorrhage is the major cause of obstetrical hemorrhage. Uterine atony is the most common cause of postpartum hemorrhage, and resulted from poor uterine contraction after delivery of the fetus and placenta. Initial management to control postpartum uterine atonic bleeding is based on the use of uterotonics such as well known oxytocin and ergot preparations together with uterine massage. Prostaglandin E2 analogue, sulprostone can be used next when these agents are failed to produce uterine contraction. The woman unresponsive to non-surgical managements requires surgical interventions including emergency hysterectomy. Recently prostaglandin E1 analogue, misoprostol, has been known to elicit potent uterine contraction and cervical ripening after oral, vaginal or rectal administration. We have experienced two cases of postpartum uterine atonic bleedings which were unresponsive to oxytocin, ergot, or prostaglandin E2, but were successfully controlled by rectal administration of misoprostols.
Subject(s)
Female , Humans , Pregnancy , Administration, Rectal , Alprostadil , Cervical Ripening , Dinoprostone , Emergencies , Fetus , Hemorrhage , Hysterectomy , Massage , Misoprostol , Oxytocin , Placenta , Postpartum Hemorrhage , Postpartum Period , Uterine Contraction , Uterine InertiaABSTRACT
From Jan. 1991 to Apr. 1996, 99 cases of microsurgical tubal reversal were performed in the Department of Obstetrics and Gynecology, Chunchon Sacred Heart Hospital of Hallym University. 80 cases among them were followed up over 1 year postoperatively. The results were as follows : 1. The mean age of total 99 women was 32.5 years(24~42 years), and the average interval between tubal sterilization and tubal reversal was 7.2 years(1~17 years). 2. The methods of sterilization were laparoscopic fallope ring in 59 cases(59.6 %), laparoscopic electrocautery in 30 cases(30.3 %), tubal ligation during cesarean section in 9 cases(9.1 %) and minilap in 1 case. 3. The most common reason for tubal reversal was remarriage(61 case, 61.6 %) and the next was desire for son(16 cases, 16.2 %). 4. 80 cases(81 %) among the total 99 women were followed up over 1 year postoperatively. Intrauterine pregnancy was documented in 59 cases(73.7 %), 53 viable fetuses and 6 spontaneous abortions. Ectopic pregnancy was noted in 3 cases(3.8 %). 5. Pregnancy rates according to maternal age were as follows ; 88.9 % in less than 30 years, 70.3 % in 30~34 years, 71.4 % in 35~39 years. Two normal pregnancies were resulted from 4 women over 39 years. 6. Pregnancy rates according to the method of sterilization were as follows ; 78 % in fallope ring, 89 % in tubal ligation during cesarean section, 55 % in electrocautery. The statistical differences between each groups were not significant(p = 0.053). 7. Pregnancy rates according to the site of anastomosis were as follows ; 81.4 % in isthmicisthmic, 67.1 % in isthmic-ampulla. There was significant statistical difference between them(p = 0.011). 8. Pregnancy rates according to the postoperative tubal length were as follows ; 60 % in less than 4cm, 66 % in 4~6 cm, 95.4 % in more than 6cm(p = 0.024). 9. Among the 59 pregnant women, 38 pregnancies(65.4 %) were resulted within six months after surgery, 48(82.3 %) within one year, and 55(94.2 %) within 2 years. 10. Pregnancy rates according to the interval from tubal sterilization to tubal reversal were as follows ; 89.6 % in less than 5years of interval, 74.5 % in 5~10 years, 44.4 % in 11~15 years(p = 0.230).