Effective Treatment For Postpartum Hemorrhage Research Articles

Clinical outcomes and future fertility after uterine artery embolization for postpartum and post-abortion hemorrhage.

Postpartum hemorrhage (PPH) and post-abortion hemorrhage (PAH) are life-threatening conditions. To evaluate the efficacy and safety of uterine arterial embolization (UAE) for PPH and PAH and to investigate future fertility after UAE. This study included 57 consecutive patients (mean age = 34 years) who underwent UAE for PPH (n = 46) and PAH (n = 11) at our institution between January 2011 and December 2022. Technical success, non-visualization of the peripheral portion of bilateral uterine arteries on angiography, and clinical success, complete hemostasis after UAE, were assessed. UAE-associated complications and factors related to clinical success were analyzed. Pregnancy outcomes after UAE and complications during subsequent pregnancy were investigated in 16 patients who desired fertility and were followed up for >1 year. The technical and clinical success rates were 100% and 84.2%, respectively. Sepsis (n = 1) and uterine empyema (n = 1) were observed as severe complications. Placental disorder, bleeding within 24 h after delivery or abortion, ≥1.5 shock index, ≥6 units of transfusion erythrocytes, and ≥8 obstetrical disseminated intravascular coagulation score were significantly associated with unfavorable clinical outcomes. In total, 16 pregnancies were observed in 12 patients after UAE, three of which were miscarriages and 13 were successful live births. During pregnancy, uterine rupture (n = 1) and accreta (n = 1) were observed. UAE is an effective treatment for PPH and PAH. Although UAE could preserve future fertility, careful attention should be paid to perinatal management for unusual complications.

INTRAUTERINE BALLOON TAMPONADE AS AN EFFECTIVE METHOD OF CONSERVATIVE TREATMENT OF POSTPARTUM BLEEDING

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide and accounts for approximately a quarter of all maternal deaths today. In May 2021, the World Health Organization (WHO) published updated recommendations that intrauterine balloon tamponade is an effective treatment for postpartum hemorrhage when first-line treatment is ineffective. The implementation of balloon intrauterine tamponade during postpartum hemorrhage after cesarean section appears to be safe and effective, which contributes to the reduction of both invasive procedures and the frequency of transfusions. Objective of the study To evaluate the effectiveness of the complex treatment of hypotonic postpartum hemorrhage and bleeding with placental abruption or placentaaccreta during cesarean section by using intrauterine balloon tamponade to prevent periportal hysterectomy. Methods An analysis of 30 cases of postpartum bleeding, which were treated with intrauterine balloon tamponade (IBT), and ended with effective conservative treatment without hysterectomy, was conducted. Research results and their discussion Parity of childbirth is important as a risk factor for the occurrence of hypotonic bleeding. A stretched uterus due to a large fetus was present in 4 (13.3%), twins - in 3 (10%), polyhydramnios - in 2 (6.6%), that is, every third woman had such a risk factor for bleeding. The course of childbirth plays an important role in the exhaustion of the contractile activity of the uterus and the occurrence of postpartum bleeding. Massive obstetric bleeding was more than 1.5% of the weight in 3 (13.6%) women, up to 1.5% in 17 (77.2%), up to 1% in 2 (9.2%). Intrauterine balloon tamponade was performed for the treatment of PPK after ineffective first-line measures. According to our data, finding an intrauterine balloon gradually stopped the bleeding. 1 hour after UBT of the uterus, the amount of blood loss decreased to 400 ml per hour, gradually decreasing to 4-6 hours. After 6 hours of VBT being in the uterus, the bleeding was stopped and the volume of circulating blood was restored. Conclusions Thus, women who have a history of massive postpartum bleeding, multiparous women, pregnant women with a stretched uterus due to a large fetus, multiple pregnancy, women who give birth with a violation of the contractile activity of the uterus are a risk group for the occurrence of postpartum bleeding. Intrauterine balloon tamponade is an effective method of conservative treatment of postpartum bleeding, which should be widely used in obstetric practice.

Modified sandwich embolization technique for postpartum hemorrhage caused by uterine artery pseudoaneurysm: a case series.

Uterine artery pseudoaneurysm (UAP) is rare but can cause life-threatening postpartum hemorrhage (PPH). To evaluate a novel sandwich embolization technique as a treatment for PPH caused by UAP. This retrospective study included 10 patients with PPH caused by UAP who were treated using a modified sandwich embolization technique at the Radiology Department, Third Affiliated Hospital of Guangzhou Medical University between April 2009 and September 2018. Baseline clinical characteristics, intraoperative data (including treatment effectiveness) and postoperative data (including re-bleeding events and complications) were extracted from the medical records. Uterine arterial angiography showed cystic shadowing of the vascular wall during the arterial phase in all patients. Spraying of contrast agent into the pseudoaneurysm was observed for large UAPs, and the pseudoaneurysm disappeared in the venous phase. The pseudoaneurysm blood supply was from the uterine artery in 9 patients (90%) and the uterine, superior vesical, internal pudendal and nameless little arteries in 1 patient (10%). Bleeding symptoms were completely relieved in all patients after sandwich embolization. Eight patients experienced painful contractions in the perioperative period, but there were no other postoperative complications. During the 1-year postoperative follow-up, 9 patients (90%) had no re-bleeding symptoms/signs. One patient (10%), who had a pseudoaneurysm supplied by the uterine, superior vesical, internal pudendal and nameless little arteries, experienced re-bleeding 20days after surgery and was treated by hysterectomy. Modified sandwich embolization is an effective treatment for PPH caused by UAP.

Efficacy of Prophylactic Antibiotics in Bakri Intrauterine Balloon Placement: A Single-Center Retrospective Analysis and Literature Review.

Objective Bakri intrauterine balloon (BIUB) placement is an effective treatment for postpartum hemorrhage (PPH). This study aims to evaluate the risk of infection during BIUB placement. Study Design Data for all deliveries ( n = 2,144) at our institution between January 2014 and March 2018 were retrospectively reviewed. Patients diagnosed with PPH ( n = 758) were included in our analysis, further divided into BIUB ( n = 80) and non-BIUB groups ( n = 678), and subdivided into vaginal delivery (VD), elective cesarean delivery (CD), and emergency CD groups. Postpartum endometritis rate was compared in each group. A single dose of prophylactic antibiotics was administered for BIUB placement in the VD group. In the CD groups, antibiotics were administered preoperatively once, and no additional antibiotics for BIUB placement were administered. To obtain an antibiotics administration protocol to be applied during BIUB placement, we electronically searched the PubMed and Scopus databases. Results No significant differences were observed in endometritis rates between BIUB and non-BIUB groups of all groups. In the literature review, of 27 suitable publications identified, multiple doses of antibiotics were administered in 17 (62.9%) studies and none investigated the efficacy of a protocol for antibiotic. Conclusion Our protocol might be effective and sufficient in preventing postpartum BIUB placement-related endometritis.

The Association Between Intrauterine Balloon Tamponade Duration and Postpartum Hemorrhage Outcomes

(Am J Obstet Gynecol. 2017;216(3):300.e1–300.e5) Intrauterine balloon tamponade (IUBT) has been shown to be an effective treatment for postpartum hemorrhage (PPH) when first-line treatments fail, but the optimal duration of IUBT with regard to PPH-related outcomes remains unknown. The authors undertook the present study to determine whether IUBT duration is associated with PPH-related outcomes, hypothesizing an association between a longer duration of IUBT and increased effectiveness in the management of PPH.

Pregnancy with asymptomatic uterine complete rupture after uterine artery embolization for postpartum hemorrhage

ObjectiveUterine artery embolization has become an effective treatment for postpartum hemorrhage. The safety of pregnancy after uterine artery embolization for postpartum hemorrhage has been established. Case reportWe present the case of a pregnant woman with asymptomatic uterine complete rupture who underwent uterine artery embolization for a previous placenta previa. She had not been diagnosed with uterine rupture until cesarean section was performed, and fortunately, we obtained the best maternal and neonatal outcomes. ConclusionMany studies have been reported that uterine artery embolization for postpartum hemorrhage did not affect subsequent pregnancy outcomes. However, we report that this procedure contains a potential risk for asymptomatic uterine rupture in a subsequent pregnancy. Although it is difficult to diagnose uterine rupture without symptoms, the obstetrician should be aware of the possibility of uterine rupture.

A novel tamponade agent for management of post partum hemorrhage: adaptation of the Xstat mini-sponge applicator for obstetric use

BackgroundAlthough uterine tamponade is an effective treatment for postpartum hemorrhage (PPH), current methods have key limitations in their use, particularly in low resource settings. The XStat™ Mini Sponge Dressing (MSD) is approved for the management of non-compressible wounds in the battlefield/trauma setting. The MSD applies highly compressed medical sponges capable of stopping high-flow arterial bleeding within seconds. The objective of our study was to adopt the MSD for use in managing PPH.MethodsWe performed desktop testing using a uterine model with pressure sensors to compare key design elements of the obstetrical prototype MSD (fundal pressure achieved, reduction in fluid loss, time to deploy, and time to remove) with alternativetechniques (uterine packing, balloon tamponade). To evaluate safety, we delivered the fetus of pregnant ewes by cesarean section and used the prototype to deliver the MSD into one uterine horn, and closed the hysterotomy. We followed the clinical recovery of animals (n = 3) over 24 h, and then removed the reproductive tract for histologic evaluation. To evaluate late effects, we surgically removed the MSDs after 24 h, and followed the clinical recovery of animals (n = 6) for an additional seven days before tissue removal.ResultsThe obstetrical prototype has a long tapered delivery system designed to be deployed during vaginal examination, and administers three times the volume of the approved MSD trauma bandage. The MSD are deployed within a mesh bag to facilitate removal by vaginaltraction. On desktop testing, the MSD resulted in the highest average fundal pressure (113 mmHg), followed by the MSD bag device (85.8 mmHg), gauze packing (15.5 mmHg), and the uterine balloon (8.2 mmHg). The MSD bag test group achieved the largest fluid flow reduction of −74%, followed by gauze packing (−55%), MSD (−35%), and uterine balloon (−19%). Animal testing demonstrated good uterine fill with no evidence of adverse clinical recovery, uterine trauma or infection at 24 h, or up to 7 days following device removal.ConclusionWe adapted a highly effective trauma dressing and applicator for use in the treatment of severe PPH. Preliminary desktop and animal testing provide a basis for initial clinical trials in women.

B-Lynch suture in the treatment of postpartum hemorrhage due to uterine atony and impact on long-term fertility

Objective To evaluate the effects of B-Lynch suture for postpartum hemorrhage due to uterine atony, and to clarify its influence on long-term fertility and next pregnancy outcome. Methods We retrospectively collected the medical records of 150 women who underwent B-Lynch suture during cesarean section due to intra-operative bleeding caused by uterine atony from January 1, 2006 to December 31, 2013 in Peking University First Hospital. Follow-up was carried out to assess postoperative menstruation and subsequent pregnancy outcomes. Results All the cases underwent B-Lynch suture which successfully retained the uterus. Satisfactory hemostasis was achieved in 131 women (87.3%) who underwent B-Lynch suture only, and in eighteen women (12.0%) who had bilateral uterine artery ascending branch ligation at the same time; and in one patient (0.7%) who underwent B-Lynch suture and uterine artery embolization four hours later due to poor uterine contraction. Of the 141 (94.0%) cases followed up after surgery, menstrual cycle was assessed in a total of 104 women: no changes in the menstrual cycle and bleeding volume were noted in 67 cases (64.4%), prolonged menstruation was observed in five cases (4.8%), menorrhagia in ten cases (9.6%), and hypomenorrhea in 22 cases (21.2%). Eleven women (23.9%) became pregnant and delivered in two to four years after the surgery, and all were full-term abdominal delivery. Conclusions B-Lynch suture is a simple, safe, and effective treatment for postpartum hemorrhage due to uterine atony, without significant change of menstruation. B-Lynch suture is not associated with infertility, and the postoperative pregnant outcome is good. Key words: Uterine inertia; Postpartum hemorrhage; Suture techniques; Fertility; Treatment outcome

The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes

Intrauterine balloon tamponade is an effective treatment for postpartum hemorrhage when first-line treatments fail. The optimal duration of intrauterine balloon tamponade for management of postpartum hemorrhage is unclear. The objective of the study was to determine whether intrauterine balloon tamponade removal >12 hours of duration is associated with postpartum hemorrhage-related clinical outcomes. This was a retrospective cohort study of women with postpartum hemorrhage from 2007 through 2014 who underwent intrauterine balloon tamponade. We excluded failures of intrauterine balloon tamponade (intrauterine balloon expulsion with duration <2 hours or if hysterectomy was required prior to planned intrauterine balloon removal). Patients who underwent intrauterine balloon tamponade for 2-12 hours were compared with those who underwent intrauterine balloon tamponade for >12 hours. Examined postpartum hemorrhage-related clinical outcomes included estimated blood loss after intrauterine balloon tamponade placement, blood product transfusion, use of adjuvant measures to control postpartum hemorrhage after intrauterine balloon tamponade (either uterine artery embolization or hysterectomy), and maternal intensive care unit admission. Secondary outcomes examined included postpartum fever and hospital length of stay. Multivariable logistic regression models were used to control for confounding variables. Of 274 eligible women, 206 (75%) underwent intrauterine balloon tamponade for >12 hours and 68 (25%) underwent intrauterine balloon tamponade for 2-12 hours. The median estimated blood loss after intrauterine balloon tamponade placement (190 vs 143 mL, P=.116) as well as the frequencies of blood product transfusion (62.1% vs 51.5%, P= .120), transfusion of ≥4 U of packed red blood cells (17.0% vs 14.7%, P= .659), uterine artery embolization (15.1% vs 16.2%, P= .823), hysterectomy (0.0% vs 1.5%, P= .248), and intensive care unit admission (8.7% vs 7.4%, P= .721), was not statistically different between the groups, and this lack of association persisted in multivariable regressions. Intrauterine balloon tamponade duration >12 hours was associated with a higher frequency of postpartum fever (27% vs 15%, P= .047) and a longer mean hospital length of stay (3.7 vs 3.1 days, P= .002). After adjusting for variables that differed statistically between groups, the difference in length of stay associated with intrauterine balloon tamponade duration was no longer present, but the association between intrauterine balloon tamponade duration >12 hours and postpartum fever persisted (odds ratio, 2.33, 95% confidence interval, 1.07-5.11). Including chorioamnionitis as an independent variable in a post hoc multivariable analysis diminished the association between intrauterine balloon tamponade >12 hours and postpartum fever (adjusted odds ratio, 2.04, 95% confidence interval, 0.92-4.53). There are no significant differences in postpartum hemorrhage-related outcomes associated with intrauterine balloon tamponade duration >12 hours compared with removal 2-12 hours. If ongoing hemorrhage has abated, it is reasonable to consider the removal of an intrauterine balloon by 12 hours after its initial placement.

Uterine Compression Sutures as an Effective Treatment for Postpartum Hemorrhage: Case Series

We evaluated the role of uterine compression sutures as a conservative treatment for postpartum hemorrhage (PPH) after failed medical treatment. We retrospectively reviewed the charts of all patients who delivered between 2003 and 2009 at a single tertiary care center and who underwent uterine compression sutures for PPH. Twelve women had uterine compression sutures for PPH. The mean age of the patients was 36.3 ± 5.2 years. The mean gestational age at delivery was 37.7 ± 2.0 weeks, and the average estimated blood loss was 2.1 ± 1.1 L. The mean procedure time to perform the uterine compression sutures was 9.3 ± 2.8 minutes. The success rate of compression sutures was 92% with only one failure resulting in a hysterectomy. Uterine compression sutures are an effective method for the treatment of PPH, thus avoiding hysterectomy and preserving potential fertility.

Uterine necrosis associated with acute suppurative myometritis after angiographic selective embolization for refractory postpartum hemorrhage

We report a case of a woman in whom uterine arterial embolization was performed using absorbable gelfoam particles for control of refractory postpartum hemorrhage. Ten days after delivery, the woman experienced high fever and low abdominal pain. Histologic findings after hysterectomy were consistent with uterine necrosis and acute suppurative myometritis.

Clinical analysis of 68 cases with improved B-Lynch suture for postpartum hemorrhage of cesarean section

Objective To observe the clinical efficacy of improved B-Lynch suture in the treatment of postpartum hemorrhage of cesarean section caused by uterine inertia.Methods There were 98 cases of postpartum hemorrhage during cesarean section from 2006.1 to 2009.12.68 cases of postpartum hemorrhage of cesarean section treated with B-Lynch suture served as the study group.30 cases of parturient patients treated with tradition technique for postpartum hemorrhage of cesarean section were recruited as control group.Operation time,hemorrhage volume,puerperal morbidity and therapeutic efficacy between the two groups were compared.Results All cases in the study group were effectively stanched with preservation of uterine and no postoperative complication was found.The differences were significant for operation time,hemorrhage volume,puerperal morbidity and success rate between the study group and the control group( P ＜0.05).There was no hysterectomy in study group satisfac tory clinical results.Conclusion Improved B-Lynch suture technique is useful for its simplicity of application,life saving potential,relative safety and capacity for preserving the uterus and subsequent fertility.It is an effective treatment for postpartum hemorrhage during cesarean section. Key words: Cesarean section; Postpartum hemorrhage; Improved B-Lynch suture technique

Uterine Bracesuture Technique for Postpartum Hemorrhage of Cesarean Section

Objective To appraise the clinical results of uterine bracesuture technique in the postpartum hemorrhage caused by uterine inertia of cesarean section treatment. Methods 21 cases of postpartum hemorrhage of cesarean section treated with uterine bracesuture technique served as the research group, 19 parturient patients treated with traditional technique for postpartum hemorrhage of cesarean section were recruited as control group. Operation time,hemorrhage volume,puerperal morbidity and therapeutic efficacy between the two groups were compared. Results All the cases in the research group were effectively stanched with preservation of uterine and no postoperative complication was found. The differences were statistically significant for operation time,hemorrhage volume,puerperal morbidity and the successful rate between the research group and control group ( P < 0.05). Conclusion Uterine bracesuture technique was particularly useful because its simplicity of application,lifesaving potential,relative safety and capacity for preserving the uterus and subsequent fertility. Uterine bracesuture technique was one of effective treatment for postpartum hemorrhage. Key words: Cesarean section; Postpartum hemorrhage; Bracesuture technique

Impact of previous uterine artery embolization on fertility

To describe data on the effects of uterine artery embolization (UAE) on fertility. UAE is used to treat postpartum hemorrhage (PPH) and fibroids. This effective therapy is replacing surgery in many cases. One of the main goals of UAE is to preserve the uterus and therefore fertility (pregnancies, menses and ovarian reserve). Pregnancies after this technique have been described. The main complications encountered during these pregnancies are not only PPH but also miscarriages and cesarean deliveries after UAE for fibroids. Conflicting results varying from completely well tolerated to serious complications such as definitive negative effect on endometrium and ovary function have been reported. Nevertheless, the series differ in that they included women of different ages and used different material for vessel occlusion (definitive microparticles of varying sizes, temporary pledgets of gelatine sponge, etc.). We discuss the impact of these differences on uterus vascularization and fertility. UAE is an effective treatment for PPH and fibroids. Pregnancy is possible after UAE. Recurrent PPH is a serious and frequent complication. Synechia is also a potential complication. Desire of childbearing should be considered when choosing embolization or surgery and, in case of embolization, the choice of material used. Further studies on future fertility after UAE are needed as well as information on fertility after surgery.

Uterine necrosis following selective embolization for postpartum hemorrhage using absorbable material

Embolization of the uterine arteries with resorbable material is an effective treatment for postpartum hemorrhage. Cases of uterine necrosis were already described but with non-resorbables particles. We report two exceptional cases of uterine necrosis with failure of conservative treatment following selective embolization with gelatine.

Rectally Administered Misoprostol for the Treatment of Postpartum Hemorrhage Unresponsive to Oxytocin and Ergometrine

In Brief Objective To investigate whether rectally administered misoprostol is an effective treatment for postpartum hemorrhage unresponsive to conventional first-line management. Methods We studied 14 women with postpartum hemorrhage unresponsive to oxytocin and ergometrine (n = 10) or, when ergometrine was contraindicated, oxytocin alone (n = 4). While awaiting carboprost, misoprostol 1000 mg (five tablets) was administered rectally. Results In all 14 women, the hemorrhage was controlled, and sustained uterine contraction produced within three minutes of administration of misoprostol. Conclusion Misoprostol appears to be absorbed effectively from rectal as well as oral and vaginal mucosa. Rectally administered misoprostol appears to be an effective treatment for postpartum hemorrhage unresponsive to oxytocin and ergometrine; therefore, it might be an alternative to parenteral prostaglandins or at least minimize the number of women requiring this invasive treatment. Given that it is an inexpensive and stable drug, misoprostol has considerable potential to reduce maternal mortality from postpartum hemorrhage in developing countries. Misoprostol administered rectally proves an effective treatment for postpartum hemorrhage.