Pelvic Packing for Intractable Obstetric Hemorrhage After Emergency Peripartum Hysterectomy: A Review.

IMPORTANCE: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. Even after emergency peripartum hysterectomy (EPH), bleeding may occur in the setting of acquired coagulopathy. This type of bleeding resistant to clipping, ligating, or suturing could be successfully controlled with a pelvic packing. OBJECTIVE: This review provides an overview of the different pelvic packing techniques used after the failure of an EPH to control severe PPH. It aims to highlight the outcome of patients after packing, the morbidity and complications of packing, the timing and indications of packing, and finally the optimal duration of packing. EVIDENCE ACQUISITION: Literature relating to pelvic packing after EPH in a PPH setting was reviewed. RESULTS: Packing techniques can be divided into 2 types: pads or roller gauze and balloon pack. The overall success rate was as high as 78.8% with a mortality rate of 12.5%. No major morbidity related to the pelvic packing was documented. The optimal duration of packing is in the range of 36 to 72 hours. CONCLUSIONS: Pelvic packing should be part of the armamentarium available to the obstetrician whenever intractable pelvic hemorrhage is encountered. It is quite simple and quick to perform and requires no special medical materials, the rate of complications is very low, and the success rate is high. RELEVANCE: The pelvic packing should be particularly useful in developing countries where more advanced technologies such as selective arterial embolization are not always available. In developed countries, the pelvic packing may be a valuable temporary measure pending transport to a tertiary care facility.

[Medical treatment of endometriosis]. / Traitement medical de l'endométriose.

PREREQUISITES: Pathogenesis and pathophysiology of endometriosis, pharmacodynamics of oral contraceptives, progestagens, antiprogestagens, danazol, GnRh agonist and non-steroidal antiinflammatory. PURPOSE OF REVIEW: The aim of this paper is to systematically review the literature evidence of medical treatments for endometriosis and to summarize recently published recommendations. METHODS: Literature and recently published recommendations review via bibliographic research using Pubmed/Medline, Google scholar and Cochrane database. RESULTS: Endometriosis is an estrogen-dependent gynecological disease. Medical treatement of endometriosis induce an estrogen deprivation situation. The Oral contraceptives reduce the rate of postoperative endometrioma recurrence and should be considered an essential part of long-term therapeutic strategies.New agents promise a distinct perspective in endometriosis treatment. CONCLUSIONS: The effectiveness of medical treatmentis well established in the management pelvic pain and infertility associated with endometriosis and constitutes an important alternative or complement to surgery.