Conservative treatment for hemorrhage during mcaesarean operation / 中国实用妇科与产科杂志

Hemorrhage often occurs during caesarean section,which can lead to severe postpartum hemorrhage if not treated in time.Effective treatment can avoid serious bleeding and following complications.This paper discussed the advantages and disadvantages of various hemostasis schemes,which included uterotonics,uterine cavity tamponade,uterine compression suture,and vascular occlusion.Any hemostasis selected should be used as early as possible to achieve sufficient effect and reduce the morbidity of complications after massive hemorrhage.

Effect of uterine compression suture in the prevention and treatment of postpartum hemorrhage of cesarean section / 中国基层医药

Objective To analyze the clinical effect of uterine artery ligation combined with modified uterine compression suture in the prevention and treatment of postpartum hemorrhage.Methods A total of 107 patients with refractory cesarean section who were treated with uterine artery ligation combined with modified uterine compression suture were selected as treatment group.Of the patients treated with conventional treatment,83 patients were included in the control group.The effective hemostasis rate,clinical curative effect,incision infection,postpartum hemorrhage,blood transfusion rate,mattress rate and postoperative morbidity were compared between the two groups.Results The amount of intraoperative blood loss (1 106 ± 458.78) mL in the treatment group was significantly higher than (753.6 ±302.30)mL in the control group,the difference was statistically significant (t =1.892,P ＜ 0.05).The 24h total blood loss of the the treatment group [(1 028.89 ± 375.87) mL] was significantly higher than (813.87 ± 312.15) mL of the control group (t =3.872,P ＜ 0.05).The postoperative 24h blood loss in the treatment group [(70.86 ±19.30)mL] was lower than (73.50 ± 21.20)mL in the control group,and the difference was not statistically significant (t =0.045,P ＞ 0.05).The transfusion rate in the treatment group was 27.10％,which in the control group was higher than 10.84％,the difference was statistically significant between the two groups (x2 =7.722,P ＜ 0.05).The effective hemostasis rate in the treatment group was 99.66％ (106/107),which was significantly higher than 96.39％ in the control group (x2 =6.263,P ＜ 0.05).The rate of puerperal infection was 7.48％ in the treatment group,which in the control group was 6.02％,there was no significant difference between the two groups (P ＞ 0.05).The incision infection rate and postoperative morbidity rate were 0.00％ in the treatment group and the control group,and the two groups were treated with Ⅱ / A healing.Conclusion Uterine artery ligation combined with improved uterine compression suture in the prevention and treatment of postpartum hemorrhage has good hemostasis effect,hysterectomy rate is low,it is worthy of promoting and application.

Sutura compresiva invaginante para control de la hemorragia obstétrica / Invaginant compression suture for the management of obstetric hemorrhage

Resumen OBJETIVO: determinar el efecto de la aplicación de la sutura compresiva invaginante para control de la hemorragia obstétrica secundaria a atonía uterina. MATERIALES Y MÉTODOS: estudio retrospectivo, transversal y descriptivo. Expedientes clínicos de pacientes del Hospital de Ginecología y Obstetricia de Ciudad Cuauhtémoc atendidas entre enero 2015 a marzo 2016 a quienes se aplicó la sutura compresiva invaginante como primer procedimiento quirúrgico en hemorragia obstétrica secundaria a atonía, sin respuesta al tratamiento farmacológico. Para el análisis estadístico se utilizaron medidas de tendencia central y el programa SPSS versión 16.0. RESULTADOS: se identificaron 9 pacientes con edad promedio de 25.1 años (límites 14 y 40), edad gestacional de 37.2 semanas (límites 32 y 40). El sangrado promedio fue de 2033 mL (límites 1800 y 2500 mL). El tiempo promedio de la intervención quirúrgica fue de 49 minutos y el tiempo de colocación de la sutura de 1.8 minutos. La sutura compresiva invaginante fue efectiva como único procedimiento en 8 casos (89%). En un caso se requirieron otros procedimientos (B-Lynch, ligadura de arterias hipogástricas, histerectomía obstétrica). No se identificaron complicaciones a corto plazo asociadas con el procedimiento, ni hubo muertes maternas. CONCLUSIONES: la sutura compresiva invaginante fue efectiva, como primer procedimiento quirúrgico, para controlar la hemorragia obstétrica y sin complicaciones a corto plazo. La cantidad de casos es limitada por lo que no puede descartarse la posibilidad de complicaciones a largo plazo y la necesidad de más estudios.

Abstract OBJECTIVE: To determine the effect of the implementation of the invaginant compression suture in the management of obstetric hemorrhage due to uterine atony. MATERIALS AND METHODS: Observational, descriptive, transversal, retrospective study. Medical records from the Obstetrics & Gynecology Hospital of the city of Cuauhtémoc in Mexico in which the invaginant compression suture was used as a first option in the surgical management of an obstetric hemorrhage due to uterine atony unresponsive to pharmacological treatment, from January 2015 to March 2016. Measures of central tendency were performed for the statistical analysis using the software SPSS, version 16.0. RESULTS: nine patients were identified during the study. The mean age was 25.1 years (14-40y), the mean gestational age was 37.2 weeks (32-40w). The mean of the estimated bleeding was 2033 ml (1800-2500ml). The duration of the surgical procedure was 49 minutes, duration of the suture placement 1.8 minutes (1-3). The invaginant compression suture was effective as the only option in 8 cases (89%). In one case other procedures were required (B-Lynch suture, hypogastric arteries ligation, hysterectomy). There were no complications associated or maternal deaths reported. CONCLUSIONS: The invaginant compression suture was effective as a first surgical option in the management of obstetric hemorrhage in these patients, without short-term complications. There was a limited number of patients and long-term complications can not be ruled out. More studies to evaluate this parameter are required.

Treatment outcome of uterine compression sutures for massive postpartum hemorrhage / 대한산부인과학회지

OBJECTIVE: Uterine compression sutures such as modified B-Lynch suture or multiple square-shaped sutures of uterine body are simple methods for control of postpartum hemorrhage refractory to medical treatment. We evaluated the treatment outcome and morbidity of uterine compression sutures and analyzed clinical findings of patients undergone uterine compression sutures and postpartum hysterectomy. METHODS: From January 2005 through December 2008, we retrospectively reviewed the medical records of patients undergone uterine compression sutures or postpartum hysterectomy. We analyzed success rates of preserving uterus of uterine compression sutures according to operative indications and mode of delivery and compared maternal characteristics, operative findings, morbidities and mortality with those of postpartum hysterectomy. RESULTS: The frequency of uterine compression sutures for control of massive postpartum hemorrhage was 0.24% (73/30,677). The success rates of preserving uterus were 85.1% in uterine atony, 80.9% in placenta previa, and 40.0% in placenta accreta (P=0.051). The rates of preserving uterus of uterine compression sutures after vaginal delivery and cesarean section were 50.0% and 82.6%, respectively (P=0.164). The frequencies of postoperative morbidities such as disseminated intravascular coagulation, pulmonary edema, ileus were not different between immediate hysterectomy and hysterectomy after uterine compression sutures. There was no maternal mortality. CONCLUSION: Uterine compression suture was successful method for control of postpartum hemorrhage resulting from uterine atony and placenta previa. We suggest the use of uterine compression sutures as the first-line operation for control of postpartum hemorrhage.