Uterus preservation as an alternative to an emergency hysterectomy for postpartum hemorrhage

Abstract

4. For obstetricians who perform cesarean sections who can easily perform selective ligation of the uterine and hypogastric arteries, we recommend performing selec-tive ligation.5. For obstetricians who cannot perform selective ligation easily, we recommend uterine compression sutures for obstetricians who can do so easily.6. If obstetricians cannot insert compression sutures, but UAe is available, then UAe should be considered.7. Finally, if the patient has unstable vital signs and dis-seminated intravascular coagulation (DIC), or UAe is not available, emergency postpartum hysterectomy should be considered.Based on our clinical data and experience, stable vital signs without DIC are key points to consider when decid-ing to perform UAe [5]. We found a significant difference in the outcome of UAe for Ph in referred patients. Dur-ing transfer, the patients are bleeding massively and often cannot endure UAe. the health care systems in other coun-tries might not be the same as the Korean system, but in countries with similar systems, it is helpful for evaluating patients transferred with Ph.Postpartum hemorrhage is an emergency and the stand-ard management is emergency postpartum hysterectomy. Nevertheless, uterine preservation is important when pos-sible. If a hospital is not equipped to perform UAe or if the obstetricians lack skill at performing uterine preservation procedures, such as ligation of the uterine artery or uterine compression sutures, then an emergency postpartum hys-terectomy should be performed immediately.We recommend following our algorithm for preserving the uterus and reducing the morbidity associated with Ph based on our clinical experience and the article by Sadik et al. Deliveries with Ph are very dynamic, stressful, Sir,We are responding to the article by Sadik et-al. and Furkan et al. on emergency postpartum hysterectomy, which is a very important obstetrics procedure [2]. We have 1, some comments regarding the control of postpartum hem-orrhage (Ph). Sadik etal. reported the incidence, risk fac -tors, indications, outcomes, and complications of emer-gency postpartum hysterectomy. the current management of Ph focuses on preserving the uterus, using uterine artery embolization (UAe), compression suture methods, and ligation of the hypogastric or uterine artery. We have reported methods such as a modified uterine compression suture for placenta previa; i.e., the hYUNhO method, and uterine compression sutures with intrauterine balloon tam-ponade, which is helpful for preserving the uterus [3, 4].Based on Sadik et al. and our articles, we take the fol-lowing steps in the management of Ph.1. Before a delivery or cesarean section, we check for placental abnormalities using ultrasonography and a history of risk factors.2. If we are suspicious after delivery or cesarean sec-tion, we immediately start conventional management, including fundal massage and the administration of oxytocin and prostaglandins.3. We monitor the vital signs closely, obtain a complete blood count and differential, and consider the use of blood products.