Abstract
Surgical Management of Massive Postpartum Hemorrhage with Uterine Atony
Highlights
Postpartum hemorrhage (PPH) is an obstetrical emergency that can follow vaginal or cesarean delivery
If the initial interventions described above are not immediately successful in controlling hemorrhage, the woman is placed in stirrups in a room with facilities for general anesthesia and both vaginal and abdominal surgery
Uterine packing was advocated for treating PPH in the past, it fell out of use largely due to concerns of concealed hemorrhage and uterine over distension
Summary
If the initial interventions described above are not immediately successful in controlling hemorrhage, the woman is placed in stirrups in a room with facilities for general anesthesia and both vaginal and abdominal surgery. If the concern for concealed hemorrhage still exists, ultrasound can more effectively detect a developing hematoma when the contrast is a fluid-filled balloon as opposed to blood-saturated gauze. This technique has the advantage of being therapeutic and diagnostic when used in combination with ultrasonography in differentiating the various etiologies described above. The B-Lynch suture envelops and compresses the uterus, similar to the result achieved with manual uterine compression It has been highly successful in controlling uterine bleeding from atony when other methods have failed. Pereira described a technique in which a series of transverse and longitudinal sutures of a delayed absorbable multifilament suture are placed around the uterus via a series of bites into the subserosal myometrium, without entering the uterine cavity [19]
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