A New Surgical Way to Face Postpartum Hemorrhage

Loutfi Guennoun Abdelmounaim,Lafkir Said,Barka Rabea,N Biougnach,Harbil Driss,Tmiri Adil

doi:10.4236/ojog.2020.1090108

Loutfi Guennoun Abdelmounaim, Lafkir Said + Show 4 more

Open Access

https://doi.org/10.4236/ojog.2020.1090108

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Abstract

Objective: We introduced two novel hemostatic techniques to achieve hemostasis for postpartum hemorrhage (PPH). The first one (A: Uterus Isthmic Plication) was a new uterine compression suture, which compresses the hysterotomy site. In a severe case, we further added vessel ligation suture after performing A-suture (B-combination suture: B-suture: A + Wide Lateral Uterine Vascular Ligation). Methods: Of 140 PPH cases, 90 were with mild PPH and 40 were with severe PPH. Our policy was: perform A-suture to mild PPH and perform B (combination) to severe PPH. Study was performed during 2018-2019. The primary endpoint to evaluate the efficacy of the procedures was preserving the uterus (no hysterectomy). Results: A-procedure, performed to 90 patients with mild PPH, was effective to all 90 patients, with all preserving the uterus. B-procedure, performed 38 patients with severe PPH (excluding two patients with uterine rupture), was effective in 37 patients, with one having undergone hysterectomy due to coagulopathy. Conclusion: Uterus Isthmic Plication (A-procedure) and addition of Wide Lateral Uterine Vascular Ligation to procedure-A (B-procedure) achieved hemostasis in patients with PPH. Prospective study is necessary to confirm the present data.

Highlights

IntroductionPPH is a major cause of maternal morbidity and mortality
We introduced two novel hemostatic techniques to achieve hemostasis for postpartum hemorrhage (PPH)
With 37 patients who benefited of the combination of the two techniques (A-Loutfi procedure and B-Loutfi procedure) as already mentioned above, because they arrived with a severe post partum hemorrhage, showing signs of hemorrhagic shock on admission and the first procedure has not been sufficient because of persistence of hemodynamic parameters instability, so we have been obliged after only 10 minutes to add the second procedure

Summary

Introduction

PPH is a major cause of maternal morbidity and mortality. Death from PPH occurs in about 1 per 1000 deliveries in low-resource countries compared with 1 in 100,000 deliveries in higher-resource countries [4]. We have 130 patients out of a total of 7705 deliveries with a rate of 1.7% compared to the rates described in the literature [1] [5] [7]. This kind of accident is one of the biggest emergencies in obstetrics that we can predict only in some specific cases, but usually, we are caught unaware. To avoid a maternal, fetal or both disastrous evolution, we have to be able to act quickly and effectively, for these reasons we have developed two new surgical techniques

Results

Discussion

Conclusion