[Ligation of internal iliac arteries for sever hemorrhage in obstetric]

To assess the efficiency of arteries ligation in intractable obstetrical hemorrhage. Prospective study which concerned 53 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from January 2007 to June 2010. The average age of patients was 29.3 years. The mean parity was 2.2. Main etiology of hemorrhage were: uterine atony [62.2%], abruptio placentae [15.1%]. Coagulation disorders and hypovolemic shock were observed respectively in 20.7% and 37.7%. Blood transfusion was performed in all cases. Internal iliac arteries ligation allowed hemorrhage control in 90.5% of cases. In five cases a hysterectomy was necessary to control bleeding.. No peroperative complication were observed. Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. It is a good alternative to arterial embolization

[Emergency peripartum hysterectomy: indications and prognosis]

Detect the risk factors, indications and maternel morbidity of haemostatic hysterectomy. A retrospective study of 46 women who had haemostatic hysterectomy between 2005 and 2009. The mean age was 33.3 years. The mean parity was 3.5. 35% of patients had a previous cesarean section. The mode of delivery was: vaginal delivery [47.8%], cesarean delivery [52.2%]. The hysterectomy was subtotal in 39 cases [85%]. The indications of haemostatic hysterectomy was: uterine inertia [44%], disseminated intravascular coagulation [26%], placenta accreta [8.7%], Placenta praevia [13%], uterine rupture [8.7%]. Three patients were dead. Five patients had a depression. Six patients had a dyspareunia. Five patients had a decrease of sexual desire. Haemostatic hysterectomy is a multilating surgery giving an irreversible infertility. The development of arterial embolization avoid the appeal to this surgery

[Prospective study about 45 cases of disseminated intravascular coagulation]

Disseminated intravascular coagulation [DIC] in obstetric disorders is a severe complication. To study the frequency and means of diagnosis of DIC and the therapeutic care and maternal morbidity induced. Monocentric, prospective and descriptive study about 45 cases of intravascular coagulation in an obstetrical service collected at the University Hospital of Obstetrics and Gynecology Hedi Chaker of Sfax over a period ranging from June 2007 to June 2010. All the pregnant patients who have given birth beyond 28 weeks and have presented a DIC were selected for this study. The mean age of patients was 31.4 years. The mean parity was 2.6. The main diseases during pregnancy were: severe preeclampsia [22.2%], diabetes [28.8%], intrauterine fetal death [17.7%], previa placenta [8.8%]. The main causes of DIC were: uterine atony [44.4%], abruptio placenta [22.2%], Hellp syndrome [11.1%] and uterine rupture [6, 6%]. The lowest rate of platelets was 21000/mm3. The fibrinogen level was <0.5 g in 40% of cases. Despite reanimation and transfusion with blood products, surgical treatment was necessary in 77.7% of cases. All the patients were transferred in intensive care unit with an average stay of about three days. No maternal death was reported. DIC is a frequent complication of many obstetrical diseases. The treatment is urgent. It requires first to the cause and the shock by massive transfusions of packed red blood cells, fresh frozen plasma, and platelets, associated with antifibrinolytic drugs, if necessary