Control Postpartum Hemorrhage Research Articles

Longitudinal Parallel Compression Suture To Control PPH Due to Placenta Previa & Accreta.

Objective: To determine the efficacy and safety of longitudinal parallel compression sutures to control postpartum haemorrhage (PPH) in placenta previa/accreta patients. Methodology: This cross-sectional study was conducted at Department of obstetrics and gynaecology, Peoples University of Medical & Health Sciences for Women; Nawab shah for a period of six months from 7th June 2023 to 6th Dec 2023, after getting approval from ERB of People University of Medical & Health Science. Sample size achieved through non-probability consecutive sampling. Women fulfilling inclusion criteria were selected from the operation theatre of Obstetrics & Gynaecology, PUMHS Nawabshah. To control life threatening PPH owing to placenta previa (with or without accreta) during caesarean section, longitudinal parallel compression sutures in operating room. Outcome variables observed includes amount of blood loss, number of days stayed in the hospital, need for concurrent procedure, need of hysterectomy, and maternal death. Data was entered and analysed on SPSS 25. Results: The stitch was applied in 31 patients. The technique was effective, and successful as a single procedure in 11 patients (35.43%). 6 patients (19%) needed additional tamponade; 12 patients (38%) also received concurrent uterine artery ligation while 2 needed ovarian artery ligation. Despite concurrent procedure 3 patients ended up for hysterectomy (9.1%). The most common indication of caesarean section was placenta previa (51%), mostly done at a gestational age of 37 weeks ± 1.84 standard deviation. Mean age of the patient was 29 years. Estimated blood loss was more than 1.5 litre as seen in 22.6% of the patients and 71.6% patients need blood transfusion. Uterine atony was a common cause of PPH (51%). 51.6% of patients discharged within 3 days of surgery. Two patients expired. Conclusion: The innovative suture techniques have shown promise in improving surgical outcomes in resource-constrained environments, especially in developing countries. This effectiveness can help bridge the gap between limited resources and the need for quality surgical care. Key words: PPH, Uterine Compression Suture, Placenta Previa, Placenta Accreta.

Uterine Balloon Tamponade in Management of Postpartum Hemorrhage

Aim. To evaluate the efficacy and safety of uterine balloon tamponade for the management of postpartum haemorrhage.Materials and Methods. We have screened the Cochrane Library and PubMed for the following keywords: “intrauterine balloon tamponade”, “controlled balloon tamponade”, “controlled balloon tamponade” AND “postpartum bleeding/haemorrhage” during 5 years (2018-2023). In total, we have identified 358 publications including 3 meta-analyses, 6 systematic reviews, and 13 randomized controlled trials. After checking titles and abstracts to remove duplicates, we selected 38 sources which met the selection criteria.Results. Postpartum haemorrhage remains the leading cause of maternal mortality in both developing and developed countries. In most cases, postpartum haemorrhage occurs due to atony and is controlled by administration of uterotonics. However, if uncurbed, postpartum haemorrhage requires blood transfusion and surgery. Currently, uterine balloon tamponade is considered as one of the most efficient and safe technologies for controlling postpartum haemorrhage and preventing hysterectomy, yet a number of studies have reported negative results. Several investigations showed an advantage of double-balloon tamponade as it provides an additional benefit of vascular compression of the lower uterine segment. Generally, uterine balloon tamponade is an efficient intervention which allows to avoid additional surgeries (uterine artery embolization or hysterectomy) in 87.3 – 100.0% of cases with a relatively low complication rate (< 6.7% – 9.4%).Conclusion. The effectiveness of uterine balloon tamponade and the risk of complications are probably determined by the type of device, the learning curve effect, and the regularity and quality of training of medical personnel. Further in-depth multicenter studies in this direction are required.

Uterine Balloon Tamponade: An Effective Tool for Managing Postpartum Haemorrhage

This article explores the crucial subject of Uterine Balloon Tamponade (UBT) as a very efficient method for controlling postpartum haemorrhage (PPH). Maternal mortality continues to be a pressing issue in global health, with postpartum haemorrhage playing a prominent role in this troubling pattern. This study investigates the versatile operational processes of UBT devices, with a particular focus on their capacity to stimulate uterine receptors, initiate contractions, and exert hydrostatic pressure to halt bleeding sinuses. The research highlights the crucial importance of healthcare workers, namely nurses, in promptly identifying and skillfully implementing UBT to achieve hemostasis. This resource offers a comprehensive examination of the many factors that contribute to postpartum haemorrhage (PPH), including uterine atony and retained placental fragments. It emphasises the need of implementing focused therapies to address these causes. The article highlights the worldwide inequalities in maternal healthcare and proposes comprehensive measures to tackle shortcomings in healthcare facilities, improve accessibility, and invest in highly qualified healthcare professionals. Evidence-based procedures, including UBT, are promoted for wider application, needing intensive instructional programs for healthcare practitioners. It is recommended that policymakers give high importance to maternal health on the international agenda, promoting cooperation across different fields of study and involving the community. In conclusion, the abstract highlights the need of taking proactive steps and working together to include UBT as a primary intervention in the management of PPH, with the main objective of decreasing global maternal death rates.

Emergency Peripartum Hysterectomy and its Outcome in a Tertiary Care Hospital in Dhaka City, Bangladesh

Introduction: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. EPH is a challanging but life saving obstetric procedure performed when medical and surgical conservative measures fail to control postpartum haemorrhage .The present study aimed to review the peripartum hysterectomies and to compare the incidence, indications and outcome of EPH. Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Dhaka, Bangladesh. Total 62 cases have taken, who had hysterectomy that was performed in Obstetric and gynaecology department of Addin Womens Medical College Hospital during the period between January 2020 and December 2022. Result: There were total of 36371 deliveries over the study period and EPH was performed in 62 cases making an incidence of 0.408. In this study 33.8% patients were between 35 to 39 years. Here 45.16% had their parity between 2nd and 3rd child. Here 61.2% had previous history of caesarean section, 24.19% had previous history of antepartum haemorrhage, 74.19% cases intrapartum operation had done. Among 62 cases of EPH 77.4% cases subtotal hysterectomy had done. Here, among 62 cases of caesarean section 35.48% had placenta accrete and 20.96% had history of placenta previa with haemorrhage and 12.9% had severe PPH due to atony of uterus. 22.5% cases had fetal outcome of still born but 32.25% baby born alive. In this study 51.6% cases patients develop haemorrhage as perioperative complication, 19.5% develop shock but 100% required blood transfusion among which 50% were in post operative period. Here 6 out of 62 cases had bladder injury, 5 patients needed relaparotomy due to haemoperitoneum caused by vaginal cuff bleeding. Mortality rate was 4.83%. Conclusion: Now a days the indication of EPH has changed from uterine atony to abnormal placentation. It is a most important obstetric surgery performed in life threatening haemorrhage. Involvement of an experienced obstetrician at an early stage of management and efforts should be taken to reduce morbidity and mortality. Sir Salimullah Med Coll J 2023; 31: 107-111

Effiacy of nausicaa compression sutures in terms of PPH management

ABSTRACT;
 BACKGROUND:Postpartum haemorrhage(PPH) is the most importantr cause of maternal death in Pakistan.Over 125,000 maternal deaths have been reported each year due to PPH. Major causes of PPH include uterine atony and haemorrhage from the placental bed. There is a recent increase in the rate of cesarean section which has increased the incidence of Placenta previa as well as placenta accreta spectrum. Apart from medical management, there are various conservative surgical interventions before imparting to hysterectomy such as uterine compression sutures which effectively secure hemostasis. The Nausicaa compression suture has been a new technique which effectively controls PPH in patients with uterine atony, placenta previa and accrete spectrum.
 OBJECTIVE: The objective of this study is to determine the efficacy of Nausicaa compression sutures in patientswith PPH undergoing cesarean section.
 PATIENTS AND METHOD: This study was conducted in the Obstetrics and Gynaecology department of Sir Ganga Ram Hospital,Lahore from 1st September2020 to 30th June,2022. Total of 80 patients who had PPH during cesarean section due to uterine atony or placenta previa spectrum were enrolled after informed consent. Nausicaa compression suture was applied to the anterior, posterior and both uterine walls where required.Successful procedure was those where only Nausicaa compression suture was sufficient to control PPH.
 RESULTS:The average age of patients was 30.3±4.2 years. There were 24(30%) primigravidas, 28(35%) were G2P1+0 and 28(35%) were multigravidas. The mean gestational age of patients was 37.58 weeks. 46 patients were operated on for indication of placenta previa. 6 patients had placenta accrete. 28 patients had other indications of LSCS. In 9 patients Nausicaa sutures were applied to the anterior uterine wall while in 71 patients to anterior and posterior uterine walls. In 62 patients Nausicaa suture was sufficient to control PPH. 10 patients required other interventions, while 8 patients required emergency hysterectomy due to intractable hemorrhage.
 CONCLUSION: The Nausicaa compression suture is an effective suture to control postpartum hemorrhage in patients with placenta previa and atonic uterus. It is most effective when applied to anterior and posterior both uterine walls separately.
 KEY WORDS: Post partum hemorrhage(PPH), Nausicaa Compression suture, Cesarean section.

Early treatment with Fibrinogen γ-chain peptide-coated, ADP-encapsulated Liposomes (H12-(ADP)-liposomes) ameliorates post-partum hemorrhage with coagulopathy caused by amniotic fluid embolism in rabbits

Amniotic fluid embolism is an unpredictable and sometimes lethal complication of childbirth. Fibrinogen γ-chain peptide-coated, ADP-encapsulated Liposomes (H12-(ADP)-liposomes), which were developed as a platelet substitute, may be useful to control postpartum hemorrhage with consumptive coagulopathy. This study aimed to establish a hemodynamically stable amniotic fluid embolism animal model and evaluate the efficacy of H12-ADP-liposome infusion in the initial management of postpartum hemorrhage complicated with amniotic fluid embolism-involved coagulopathy. Pregnant New Zealand white rabbits (28th day of pregnancy or normal gestation period of 29-35 days) underwent cesarean delivery, followed by intravenous administration of amniotic fluid (a total of 3.0 mL administered in 4 doses over 9 minutes). Thereafter, uncontrolled postpartum hemorrhage was induced by transecting the right midartery and concomitant vein in the myometrium. After initial bleeding for 5 minutes, rabbits received isovolemic fluid resuscitation through the femoral vein with an equivalent volume of blood loss every 5 minutes for 60 minutes. The transfusion regimens included platelet-rich plasma, platelet-poor plasma, and a bolus administration of H12-ADP-liposomes followed by platelet-poor plasma transfusion (8 rabbits per group). Moreover, 60 minutes after initiation of bleeding, rabbits received surgical hemostasis by ligation of bleeding vessels, except in cases with spontaneous hemostasis. The administration of amniotic fluid caused thrombocytopenia (56±3 × 103/μL) and prolonged both clotting time (before administration: 130.0±3.0 to 171.0±5.0 seconds) and prothrombin time (4.5±0.1 to 4.7±0.1 seconds). After the initial 5-minute bleeding in the rabbits, the mean arterial pressure fell to 43±2 mm Hg. Platelet-poor plasma transfusion alone further prolonged clotting time and prothrombin time at 60 minutes (192.0±10.0 and 5.2±0.1 seconds, respectively) with decreasing mean arterial pressure to <40 mm Hg. By contrast, the administration of H12-ADP-liposomes followed by platelet-poor plasma transfusion reduced the prolonged clotting time (153.0±5.0 seconds) and prothrombin time (4.9±0.1 seconds) similar to platelet-rich plasma transfusion (154.0±11.0 and 4.9±0.1 seconds, respectively) at 60 minutes. These rabbits maintained a mean arterial pressure of >45 mm Hg throughout the experiment. H12-ADP-liposome infusion and platelet-poor plasma transfusion and platelet-rich plasma transfusion yielded spontaneous hemostasis in 4 of 8 rabbits, whereas platelet-poor plasma transfusion did not stop bleeding in any of the rabbits. The total blood loss was 59±17 mL in the H12-ADP-liposomes and platelet-poor plasma group, which was half of that in the platelet-poor plasma group (124±10 mL). H12-ADP-liposome infusion may be effective in the initial management of postpartum hemorrhage complicated with amniotic fluid embolism, resulting in mitigation of consumptive coagulopathy.

Effect of Carboprost Tromethamine Combined with Uterine Strap Suture in the Treatment of Patients with Postpartum Hemorrhage Caused by Uterine Atony

Objective: To explore and analyze the effect of carboprost tromethamine combined with uterine strap suturein the treatment of postpartum hemorrhage caused by uterine atony. Methods: A total of 90 patients with postpartum hemorrhage due to uterine atony who were admitted to the Obstetrics Department of Dazhou Women and Children’s Hospital from July 2020 to July 2023 were included in the study. They were grouped by odd and even numbers, and divided into the surgery group (n = 45) and the drug group (n = 45). The surgery group was treated with carboprost tromethamine and uterine strap suture, and the drug group was treated with carboprost tromethamine. The total effective rate, blood coagulation index, fibrinolytic function level, bleeding, and hemoglobin changes were compared between the two groups. Results: The total effective rate of the surgery group was significantly higher than that of the medication group (P &lt; 0.05). Before treatment, the blood coagulation indicators were insignificant between the groups (P &gt; 0.05); after treatment, the blood coagulation indicators in the surgery group were significantly better than those in the drug group (P &lt; 0.05). Before treatment, the levels of fibrinolytic functions were insignificant between the groups (P &gt; 0.05); aftertreatment, the levels of fibrinolytic functions in the surgery group were significantly better than those in the drug group (P &lt; 0.05). The 2 h and 24 h blood loss and hemoglobin changes in the surgery group were significantly lower than those in the drug group (P &lt; 0.05). Conclusion: Carboprost tromethamine combined with strap sutures can effectively control postpartum hemorrhage caused by uterine atony.

Correction to: Is it worth to insert uterine pack instead of Bakri balloon to control postpartum hemorrhage after vaginal delivery in hypertensive patients?

Correction to: Is it worth to insert uterine pack instead of Bakri balloon to control postpartum hemorrhage after vaginal delivery in hypertensive patients?

Mostafa Maged Maneuver to Control Post-Partum Hemorrhage during Vaginal Delivery.

This study is aimed to introduce a new technique used in controlling the postpartum bleeding during normal vaginal delivery. This study was conducted on 150 pregnant women aged 18 years or more who were eligible for normal vaginal delivery. After placental delivery, Mostafa Maged maneuver was applied. The amount of blood loss was estimated by counting the number of pads immediately before applying the maneuver compared to the number of pads immediately after applying the maneuver to determine the effectiveness of the Mostafa Maged maneuver. The study revealed that 15.3% of the study group had atony, and 23.3% were complicated with postpartum hemorrhage. In terms of blood loss, the average number of pads used before Mostafa Maged compression was (2.8) pads, with a range of 1 to 6 pads. The mean blood loss volume was (353.3±158.5) ml ranging between 125 and 750 ml. we should consider that Mostafa Maged maneuver is immediately applied after placental delivery. That is why small amount of 125 ml of blood loss in few patients is estimated, which decreased to (0.54±0.14) pads ranging between 0.5 and 1 pad with a mean (65.2±17.7) ml blood loss ranging between 60 and 125 ml after applying Mostafa Maged maneuver during normal vaginal delivery. There was a statistical decrease in the number of pads and volume of blood loss after Mostafa Maged maneuver. Mostafa Maged maneuver was found to be effective in stopping and preventing postpartum bleeding during vaginal delivery as this maneuver is used as a prophylaxis against post-partum hemorrhage in patients with risk factors of postpartum hemorrhage. It is also used to control post-partum hemorrhage during vaginal delivery. It has been proven to be tolerable, easy to learn and easy to perform.

Efficacy of Uterovaginal Packing Versus Uterine Balloon Tamponade to Control Postpartum Hemorrhage Due to Uterine Atony

OBJECTIVES To determine and compare the efficacy of Uterovaginal packing versus uterine balloon tamponade to control postpartum haemorrhage due to uterine atony unresponsive to medical treatment. METHODOLOGY This comparative prospective cross-sectional study was conducted in Hayatabad Medical Complex, OBG department. A total of 140 patients were categorised into two groups, group A underwent Uterovaginal packing and group B underwent uterine balloon tamponade. All women of 18 to 40 years with a history of delivery after 28 weeks of gestation, who developed primary postpartum haemorrhage due to uterine atony, unresponsive to medical treatment were included in the study. Women with a history of delivery before 28 weeks of gestation, secondary postpartum haemorrhage, genital tract trauma, retained placental tissue and membranes, placenta previa, morbidly adherent placenta, febrile illness and uterine structural lesion were excluded from the study. Efficacy was labelled if there was no ongoing blood loss after the procedure with concomitant hemodynamic stability. All information was recorded in a predesigned proforma, and data were analysed using SPSS version 22.RESULTS Our study included 140 women; 113 had a normal vaginal delivery, and 27 underwent cesarean section. Among cases with normal vaginal delivery, 45 women had Uterovaginal packing, and 68 had uterine balloon tamponade, while among cases of cesarean sections, 25 women had uterovaginal packing and 2 had uterine balloon tamponade. The efficacy of Uterovaginal packing was 90%, and that of uterine balloon tamponade was 87.1%, with no significant difference statistically (p- 0.51). Overall efficacy of both procedures was 88.6%.CONCLUSION All orthodontic and non-orthodontic treatment group participants required oral hygiene instructions and had periodontal treatment needs (TN1). The patients requiring scaling and prophylaxis and Oral hygiene instructions (TN 2) were more in the orthodontic treatment group than the non-orthodontic treatment group. A higher percentage of patients requiring complex treatment (deep scaling, root planning and complex surgical procedures), scaling and prophylaxis and Oral hygiene instructions (TN3) belonged to the non-orthodontic treatment group.

Uterine tamponade in postpartum hemorrhage with handmade balloons: Comparison of manufacturing, infusion, and total times.

To compare the manufacturing, infusion, and total times of handmade balloons for uterine tamponade using the El Hennawy and Alves techniques, given the failure of initial measures and uterotonic therapy to control postpartum hemorrhage. An open clinical trial (clinical article) was conducted among 30 physicians, residents, and assistants in an Obstetrics Department. Each participant manufactured and infused one of two different balloons compared in the study, in a randomly predefined sequence. The manufacturing and infusion times were timed by the researchers and their medians were compared using the t test or Mann-Whitney U test. The manufacturing time of the El Hennawy balloon was 72 s lower in relation to the Alves balloon (P< 0.010). Regarding the infusion time, the Alves balloon was filled faster than the El Hennawy balloon (P< 0.010). The total time (manufacturing and infusion) of Alves balloon was also lower than the El Hennawy device (P< 0.010). Although the El Hennawy balloon was manufactured more quickly, the total time of manufacturing and infusing the Alves balloon was much faster, which makes it the most suitable device to be used in critical situations of postpartum hemorrhage.

META-ANALISIS DETERMINAN PERDARAHAN POSTPARTUM

&lt;em&gt;Postpartum haemorrhage is the most common cause of all deaths from obstetric haemorrhage. Postpartum haemorrhage is bleeding that exceeds 500 ml after the baby is born in vaginal delivery and exceeds 1000 ml in cesarean section or bleeding that is more than normal which has caused changes in vital signs. The purpose of this study was to determine the determinants of postpartum hemorrhage from national and international research publications with meta-analyses. Identify study articles by searching through Pubmed, Springer Link, Google Scholar database searches on the internet. Assessment of the quality of the studies included in this study were selected in advance, the selected journals were publication journals that were relevant to the research question, original research (original), indexed Scopus Q1, Q2, Q3, Q4 and indexed Sinta (S1, S2). The research study used was an observational cohort, case-control and cross-sectional design study. Statistical analysis using the fixed effect model or random effect model to see the estimated specific effect and the combined determinants of postpartum hemorrhage and sensitivity test to see the stability of the variables to changes. Data analysis software uses RevMan 5.4. The results showed that there were 13 countries out of 20 selected journals, the estimation of the determinant effect of Postpartum Hemorrhage in Asia from the meta analysis obtained age had an OR of 2.52 (95% CI: 1.83-3.47). Parity has an OR of 2.54 (95% CI: 1.22-5.31). Anemia has an OR of 3.43 (95% CI: 1.65-7.11). History of childbirth has an OR of 3.40 (95% CI: 2.62-4.42). Stress has an OR of 2.06 (95% CI: 0.46-9.31). Education has an OR of 1.27 (95% CI: 0.23-6.94). Lifestyle has an OR of 1.48 (95% CI: 0.85-2.22). It was concluded that the determinant of postpartum hemorrhage in Asia was anemia with the highest OR of 3.43. It is hoped that this can be used as a guideline for stakeholders in the health sector in determining program priorities to prevent and control postpartum hemorrhage problems. The results of the research can directly provide knowledge to the public about the determinants of postpartum hemorrhage and how to manage pressure to control and avoid postpartum hemorrhage&lt;/em&gt;

Pivotal Role of Management of Postpartum Haemorrhage by Using Intrauterine Pack during Caesarean Section

Background: Postpartum Haemorrhage (PPH) is a potentially life-threatening complication after delivery by both vaginal and caesarean section (CS). Different types of management options have been available in clinical settings including the use of oxytocin, prostaglandin analogues, ergometrine, surgical exploration of genital tract, ligation or angiographic embolization of uterine or internal iliac arteries and hysterectomy. Another simple and effective measure to manage PPH is to control the bleeding with intrauterine packing by mop during CS. This intrauterine packing during CS is very easy &amp; quick method to perform and it has pivotal role to save the patient need of major surgical procedures.&#x0D; Objective: To determine effectiveness of uterine packing by mop in control of post-partum hemorrhage, its safety and complications associated with it.&#x0D; Materials and Methods: This study was carried out in Obstetrics &amp; Gynaecology department of Eastern Medical College &amp; Hospital, Cumilla, Bangladesh from January 2020 to July 2020. It was a prospective interventional study. the patients presenting with postpartum haemorhage during CS due to atonic uterus. Patients who had PPH due to genital tract trauma were excluded from this study. Frequencies and proportions of complications were calculated along with rate of successful cessation of bleeding by the use of intrauterine mop. Data was analyzed by SPSS.&#x0D; Results: 100 patients included in the study. Among them 63% were 25-34 years, 26% were 15-24 years, 11% were 35-45 years. 73% patients were p &gt;3 and 27% were p 1-3. 77% patients belong to poor class family, 18% belong to middle class and 5% belong to high class family. These patients went through LUCS and had atonic uterus. Mop was used in those patients and successes rate were 87%. In 13% cases we needed others management. These were 11% case uterotonic drugs, 1% B-Lynch suture, 1% internal iliac artery ligation but none out of 100 patients underwent hysterectomy.&#x0D; Conclusion: Uterine packing by mop effectively controls PPH with fewer complications and its role in emergency obstetric scan not be denied.&#x0D; EMCJ. July 2022; 7(2): 1-5

Prevention and Control of Postpartum Hemorrhage: Validation of Rangel’s Technology for Huambo, Angola

Prevention and Control of Postpartum Hemorrhage: Validation of Rangel’s Technology for Huambo, Angola

Case 2023-1: Anesthesia Management of Postpartum Hemorrhage

Closed Claims Case Review| January 2023 Case 2023-1: Anesthesia Management of Postpartum Hemorrhage ASA Monitor January 2023, Vol. 87, 13. https://doi.org/10.1097/01.ASM.0000911732.97913.e2 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Case 2023-1: Anesthesia Management of Postpartum Hemorrhage. ASA Monitor 2023; 87:13 doi: https://doi.org/10.1097/01.ASM.0000911732.97913.e2 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: postpartum hemorrhage control, hemorrhage, resuscitation A 24-year-old woman, G1P0 at 41 weeks gestation, had an uneventful vaginal delivery facilitated by epidural analgesia at a medium-sized community hospital with an expanding labor and delivery service. Postpartum vaginal bleeding persisted despite administration of Pitocin and methergine. Attempts to place a Bakri uterine balloon for tamponade were unsuccessful at the bedside due to patient discomfort and agitation. Blood pressure declined despite administration of a fluid bolus, and the anesthesiologist was called for assistance with sedation and resuscitation. At arrival of the anesthesiologist, blood pressure was 80/60 by automated cuff, with heart rate of 110. Postpartum blood loss was substantial but could not be accurately estimated. The anesthesiologist placed a second I.V., with difficulty, ordered transfusion of two units of red blood cells (RBCs), and requested equipment for an arterial line. Both the arterial line and the blood products were delayed as support personnel were called in from home.... You do not currently have access to this content.

Trans-arterial embolization for intractable primary postpartum hemorrhage caused by arterial aneurysms with arteriovenous fistulas in the lower vagina bilaterally: a case report

Failure of conservative management for controlling postpartum hemorrhage (PPH) is not uncommon, particularly when PPH is caused by vascular lesions. Awareness of this possibility and initiating timely trans-arterial embolization (TAE) are essential for improving the outcome. Herein, we describe the case of a 34-year-old woman presenting with arterial aneurysms with arteriovenous fistulas in the lower vagina bilaterally, which caused intractable PPH. Conservative management failed to resolve the PPH; however, TAE successfully controlled the bleeding, and the patient recovered smoothly. Knowledge of this possible etiology for intractable PPH is crucial for timely TAE. This case report aims to highlight the pivotal role of TAE in detecting and treating this unusual cause of PPH.

Procedural techniques to control postpartum hemorrhage.

Postpartum hemorrhage can occur unexpectedly and with high dynamics. The mother's life often depends on quick action and good communication within an interdisciplinary team. Knowledge of each other's therapeutic options plays a major role. Treatment procedures include obstetric, surgical, and radiologic techniques. In addition to availability and experience with the techniques, two important aspects must be considered in the selection process: the type of delivery and the cause of the hemorrhage. In particular, the distinction between pregnancies with or without disturbed placentation from the placenta accreta spectrum is crucial. From these two points of view, we discuss here different uterus-preserving and uterus-removing techniques. We describe in detail the advantages and disadvantages of each procedure. Because most therapeutic options are based on small case series and uncontrolled studies, local circumstances and physician experience are critical in setting internal standards.

Appraisal of Foley’s Catheter as Intra-Uterine Balloon Tamponade in controlling Post-Partum Hemorrhage.

Objective: To appraise the efficacy of Foley’s catheter as balloon temponade in controlling PPH. Study Design: Monocentric Retrospective Impact study. Setting: Department of Obstetrics and Gynaecology of MTI, Hayatabad Medical Complex Peshawar. Period: January 2020 to December 2020. Material &amp; Methods: This is a tertiary care hospital receiving all kind of patients including complicated cases referred by other health care units. All patients of PPH due to uterine atony who failed to respond to medical treatment were managed by using a Foley’s catheter balloon tamponade and made part of this study. Patients with PPH due to genital tract trauma and retained products or whom responded to medical treatment were excluded. The information and relevant data was obtained from the patient’s record and mortality register. Data was analyzed using simple statistical measures and the outcome expressed as frequencies and percentages etc. Results: In this study, 204 patients of PPH due to uterine atony were managed. 83 patients who failed to respond to medical treatment were managed by using a Foley’s catheter balloon tamponade. Balloon tamponade was effective in controlling PPH in 78 (93.98%) cases. Only 5 (6.02%) patients needed further surgical intervention. Conclusion: This study concludes that Foley’s catheter can effectively be used for controlling PPH to save lives and morbidity.

Therapeutic effect of Internal iliac artery ligation and uterine artery ligation techniques for bleeding control in placenta accreta spectrum patients: A meta-analysis of 795 patients.

Placenta accreta spectrum (PAS) can cause complications like hysterectomy or death due to massive pelvic bleeding. We aim to evaluate the efficacy of two different arterial ligation techniques in controlling postpartum haemorrhage and minimizing bleeding complications. We searched six databases. 11 studies were finally included into our review and analysis. We graded their quality using the Cochrane tool for randomized trials and the NIH tool for retrospective studies. Our analysis showed that internal iliac artery ligation has no significant effect on bleeding control (MD = −248.60 [−1045.55, 548.35] P = 0.54), while uterine artery ligation significantly reduced the amount of blood loss and preserved the uterus (MD = −260.75, 95% CI [−333.64, −187.86], P < 0.00001). Uterine artery ligation also minimized the need for blood transfusion. Bleeding was best controlled by combining both uterine artery ligation with uterine tamponade (MD = 1694.06 [1675.34, 1712.78], P < 0.00001). This combination also showed a significant decrease in hysterectomy compared to the uterine artery ligation technique alone. Bilateral uterine artery ligation in women with placenta accreta spectrum can effectively reduce the amount of bleeding and the risk of complications. The best bleeding control tested is a combination of both, uterine artery ligation and cervical tamponade. These techniques may offer an easy and applicable way to preserve fertility in PAS patients. Larger randomized trials are needed to define the best technique.

Bilateral Internal iliac artery ligation: A life saving conservative management to control postpartum haemorrhage- clinical experiences

It has been since long, that severe postpartum haemorrhage (PPH) was surgically treated by peripartum hysterectomy. Bilateral ligation of Internal iliac artery is an emerging technique by which we can control PPH efficiently and can conserve uterus. The aim of our study, is to estimate the effectiveness of bilateral Internal iliac artery ligation (IILA) for conservation of uterus in the management of postpartum haemorrhage and outcome on the patients.This observational study was carried out on the admitted patients in between March, 2016 and February, 2020in a hospital having a tertiary obstetric care. Internal iliac artery ligation done to control postpartum haemorrhage of hospital admitted patients, was our study subject. Collected data were analysed in mean, median, percentage and proportion as applicable by using of SPSS version 24 statistical software.In the study population, out of forty-one patients, uterine conservation was possible in thirty-six (87.8%) patients. Most commonly sixteen (39%) patients had an indication of uterine atony for Internal iliac artery ligation. Caesarean section, thirty-four (82.9%) was the most common mode of delivery and general anaesthesia was used most commonly, thirty-seven (90.2%) for Internal iliac artery ligation. Procedure related complications were e.g. relaparotomy one (2.4%), Internal iliac vein injury two (4.9%) and wound infection two (4.9%).Internal iliac artery ligation is an effective means to control PPH. It can effectively preserve reproductive potential of women by avoiding peripartum hysterectomy in many cases. Postpartum hemorrhage is a life threatening complication of child birth. Peripartum hysterectomy is the last resort to tackle such complications. Our study, confirmed that bilateral internal iliac artery ligation can be a good alternative to tackle such disaster from postpartum hemorrhage and also conserve uterus of women for future reproduction.