Vaginal ligation of descending branch of uterine artery in the management of massive secondary post-partum haemorrhage

A 25 year old lady presented on day 22 of an uneventful caesarean delivery, in a state of class IV haemorrhagic shock, secondary to sudden onset of vaginal bleeding without any inciting cause. Immediate resuscitation was initiated and the cause for massive secondary post-partum haemorrhage (PPH) was identified as an actively bleeding vessel at 3 ‘O’ clock position on a visibly healthy cervix with a well contracted uterus. This was the descending branch of left uterine artery, which was ligated after pulling the cervix with a sponge holder towards the introitus and application of Vicryl No 1-0 suture. The bleeding decreased significantly post vascular ligation. Further exploration of vagina and cervix did not reveal any active bleeding or laceration and no retained placental tissue was found inside uterine cavity on ultrasound examination. This is a rare case of Massive Secondary PPH in a post-caesarean patient due to spontaneous giving way of descending branch of uterine artery.

Comparison of effects between Leep knife operation and Vaginal ligation operation in submucous uterine myoma / 中国基层医药

Objective To compare the clinical application value between Leep knife operation and Vaginal ligation operation in submucous uterine myoma during the basic-level hospital.Methods According to digital table method,63 cases with submucous uterine myomas were randomly divided into the trial group and control group,33 cases in the trial group used the Leep knife,30 cases in the control group used vaginal ligation operation.Results The amounts of the trial group such as operation time,complications bleeding,operation stump bleeding rate and menstrual disorder improvement rate were (8 ± 3)min,(7 ± 3)mL,0.0％,91.0％,while the amounts of the control group were (10 ± 3) min,(10 ± 4) mL,13.3％,70.0％.The difference was statistically significant (t =2.642,3.387,x2 =4.698,4.455,all P ＜ 0.05).Conclusion Leep knife operation is better than Vaginal ligation operation,because it has shorter operation time,less complications bleeding,lower operation stump bleeding rate and higher menstrual disorder improvement rate.It is worthy of applying in the basic-level hospital.