Fast and easy provisional treatment of severe postpartum haemorrhage

Abstract

read with interest the paper by Ghezzi et al. about treating postpartum haemorrhage (PPH) successfully with the Hayman technique. The method is presented as quicker and easier than other methods. Allow me to communicate an even faster and easier method for very basic circumstances e.g. the operator is not a gynaecologist has no access to blood for transfusion or to only 1-2 pints of O negative blood and is also responsible for the child and the anaesthesia (and maybe for keeping the generator going). About 10 years ago I was presented at a referral hospital in Bulawayo Zimbabwe with a woman who had suffered from a severe PPH in a small district hospital. In desperation during the laparotomy the district doctor used a Foleys catheter as a tourniquet around the base of the uterus as is often performed with myomectomies prophylactically. He did not leave the ovarian arteries out as is possible by going through the anterior and posterior leaves of the broad ligament bilaterally beside the cervix. Understandable because there are at the end of pregnancy enormous thin walled easily bleeding veins in evidence in that area. It is also possible that closing only the uterine arteries would not have been enough. She stopped bleeding. The woman was then referred to the provincial hospital for an urgent transfusion and further transport to the tertiary hospital. The second referral was delayed for several reasons and I saw the woman only after 24 hours. On reopening the abdomen a nonvital uterus was in evidence including the adnexa. This was followed by the easiest subtotal abdominal hysterectomy including adnexa that I ever did: two sutures sufficed to substitute the catheter. The woman made an uneventful recovery and was prescribed combined contraceptive tablets to be used continuously till she was 50 years old. Without the delay it might have been possible to save the uterus and/or the ovaries. It is also often feasible to place a tourniquet low enough to stop uncontrollable bleeding after a caesarean section or a uterine rupture to gain time. (excerpt)