Massive obstetric bleeding: optimization of total hysterectomy surgery technique and conservative treatment

Abstract

Objective. Reducing maternal mortality during massive obstetric bleeding (MOB) through optimizing total hysterectomy technique and improving the quality of infusion therapy.
 Materials and methods. The analysis and evaluation of the results of MOB treatment in a comparative aspect were carried out in retrospective and prospective groups from 2014 to 2019 in Urgench perinatal center and three maternity complexes of Khorezm region, Uzbekistan. The retrospective group included 72 pregnant women with an average blood loss of 2450.0±80.0 ml, while the prospective group included 78 pregnant women with an average blood loss of 2530.0±70.0 ml.
 Results and discussion. 1,419 (6.2 %) cases out of 22,896 deliveries in the retrospective group were accompanied by abnormal blood loss, and the MOB frequency of more than 1500.0 ml was determined in 0.3 % of all deliveries. 5 (62.5 %) of 8 cases of maternal mortality were directly related to MOB. In the retrospective group, a total hysterectomy was performed using traditional method for MOB, with an interoperable blood loss of 860.0±110.0 (p<0.05). Qualitative and quantitative composition of infusion therapy in this group averaged: saline sodium chloride solution 4350,0±350.0; Heloplasm (INN) -500,0±100,0; hydroxyethylated starch 1800.0±150.0; Rheosorbilact 400.0±50.0 and fresh frozen plasma (FFP) 1650.0±110.0. Optimized version of total hysterectomy in a prospective group differs from the traditional with one “hemostatic suture” imposed on all three formations (fallopian tube, own and round ligament). Imposed first in the distal, then proximal, and on descending and ascending departments a. uterinae during the operation. The optimized version of total hysterectomy resulted in reduction of interoperative blood loss by an average of 340.0±60.0 ml in MOB and reduction of operation time by 22.0±4.0 min, thereby improving the outcome of the operation. Amount of saline sodium chloride solution was injected in average by 1900.0; Refortan by 600.0; FFP by 230.0 less, and INN, Gelofuzin by 500.0 and Rheosorbilact by 400.0 more in the prospective group than in the retrospective group.
 Conclusions. Optimized version of total hysterectomy with improved qualitative and quantitative composition of infusion therapy for MOB contributed to reduction of maternal mortality by 19.7 % in the prospective group compared to the retrospective group.