Second Intervention in Obstetric Hemorrhage

Journal of the Institute of Medicine Pub Date : 2013-11-09 DOI:10.3126/JIOM.V34I1.9118

S. Rawal, A. Rana

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Abstract

Introduction: Obstetric hemorrhage is still one of the dreaded complications that contribute to a maximum number of maternal morbidity and mortality till date. The management of obstetric hemorrhage involves early recognition, assessment and resuscitation. Though dealt with appropriate use of oxytocic agents, it may seldom require surgical techniques, including uterine tamponade, major vessel ligation, compression sutures, and even hysterectomy. Method: Prospective study of 20 cases of laparotomy for obstetrical hemorrhage carried out at Tribhuvan University Teaching Hospital, Kathmandu, Nepal, between Jan 2003 to Nov 2011. Results: Out of 20 cases, massive hemoperitoneum (more than a liter) was noted in 9 and associated risk factors in 10. Source of bleeding in 20 cases were from extensive hematoma (retroperitoneal and broad ligament) in 5, including a rectus sheath hematoma and with colporrhexis, oozing inverted T incision repaired in a single layer (1), placental bed (3) and 1 was from vessels in LUS. There was bleeding from uterine angle (4) and incision (1). Bleeding from tear at various sites were 3, from uterovesicle fold of peritoneum 1 and from the ruptured uterus following vacuum delivery in a case of VBAC (1). Uterine packing was done in 1, B-Lynch in 3 and 1 failed needing the uterine packing; uterine artery ligation in 2 including ovarian vessel ligation in 1, repair of ruptured uterus in 1 and subtotal hysterectomy in 5 cases. There were 3 mortalities due to DIC, pulmonary edema and ARF and rest were discharged in good health. Conclusion: Choosing of the right technique, complete hemostasis and meticulous closure of all surgical incisions will prevent the need for laparotomy following LSCS. Vigilant monitoring of all the post operative patients will lead to early diagnosis of intraperitoneal / pervaginal bleeding and its management, thus preventing morbidity and mortality owing to late diagnosis. DOI: http://dx.doi.org/10.3126/joim.v34i1.9118 Journal of Institute of Medicine, April, 2012; 34:1 18-24

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产科出血的第二次干预

产科出血仍然是一个可怕的并发症，有助于最大数量的产妇发病率和死亡率到目前为止。产科出血的处理包括早期识别、评估和复苏。虽然处理适当使用催产剂，它可能很少需要手术技术，包括子宫填塞，大血管结扎，压迫缝合，甚至子宫切除术。方法:对2003年1月至2011年11月在尼泊尔加德满都特里布万大学教学医院施行剖腹手术治疗产科出血的20例患者进行前瞻性研究。结果:20例患者中，9例出现大出血(大于1升)，10例出现相关危险因素。出血来源为广泛血肿(腹膜后及阔韧带)20例，其中5例为直肌鞘血肿并合并阴道裂、渗出倒T切口单层修复(1例)、胎盘床(3例)，1例为LUS血管出血。子宫角(4例)和切口(1例)出血，各部位撕裂出血3例，腹膜子宫囊褶皱出血1例，真空分娩后子宫破裂出血1例(1例)。子宫填塞1例，B-Lynch 3例，子宫填塞失败1例;子宫动脉结扎2例，卵巢血管结扎1例，子宫破裂修复1例，子宫次全切除术5例。其中DIC、肺水肿、ARF死亡3例，其余健康出院。结论:选择正确的手术技术，充分止血，仔细关闭所有手术切口，可以避免LSCS术后开腹手术的需要。对所有术后患者进行警惕监测将有助于早期诊断和处理腹腔/阴道出血，从而防止因诊断晚而导致的发病率和死亡率。DOI: http://dx.doi.org/10.3126/joim.v34i1.9118 Journal of Institute of Medicine, April, 2012;34:1 18 - 24

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Journal of the Institute of Medicine

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