子宫压迫缝合术治疗产后出血

子宫压迫缝合术是一种简便高效的产后出血保守性手术方法,本文分析目前国内外的多种子宫压迫缝合术在临床应用中存在的局限性与弊端,并讨论在产后出血中的临床应用及注意事项。     

A new uterine suture technique for postpartum hemorrhage

At present, postpartum hemorrhage is still an important cause of maternal mortality and morbidity. When medical therapy has no success, conservative surgical procedures are applied before making a hysterectomy. Three transverse sutures are applied to the entire uterine wall both to the right and the left side of the uterus. Our technique has been applied to 4 women with postpartum hemorrhage secondary to uterine atony. Bleeding was stopped immediately by compressive sutures. The four patients had normal menstruation cycles after delivery and had new pregnancies. No woman had postoperative complications. Uterus compressive suture is an effective alternative to hysterectomy to treat postpartum hemorrhage secondary to atony. This is a simple and quick procedure that preserves fertility.     

Intrauterine balloon tamponade in the management of postpartum hemorrhage

This article reviews our experience with the use of intrauterine tamponade with balloon catheters in the management of severe postpartum hemorrhage. This is a case series report of 23 patients with postpartum hemorrhage unresponsive to medical therapy managed with intrauterine balloon tamponade. We identified these patients by International Classification of Diseases (ICD-9) codes and by reviewing labor and delivery logs. Balloon tamponade was attempted in 23 patients. When properly placed, catheters controlled postpartum hemorrhage in 18 of 20 cases (90%). In two cases, hysterectomy was required despite successful placement of the catheter. For hemorrhage due to uterine atony, our success rate was 100% (11/11 cases). In three cases, technical difficulties led to placement failure. For bleeding due to retained placenta, our success rate was 80% (4/5; failure with placenta percreta). Vaginal bleeding was stopped with the catheter in two of three cases of amniotic fluid embolus and in one case after dilation and curettage for postpartum septic shock. Thus balloon tamponade is an effective adjunct in the treatment of severe postpartum hemorrhage, especially when due to uterine atony when medical therapy fails.     

A new uterine compression suture for postpartum haemorrhage with atony

Postpartum haemorrhage (PPH) is a major cause of worldwide maternal mortality and is still associated with significant morbidity. After the B-Lynch suture was reported in 1997, several different uterine compression sutures were found to be successful in controlling PPH. In this paper, we describe another simple variation of the uterine compression suture technique, which was performed without an incision in the uterine wall, without entering the uterine cavity and without suturing the anterior and posterior walls of the uterus together, so minimising the trauma to the uterus. This new uterine compression suture is an effective and safe surgical treatment for PPH caused by atony. It has the potential to apply to intractable PPH after vaginal delivery.     

Ten year follow-up of the effect of the B-Lynch uterine compression suture for massive postpartum hemorrhage

The B-Lynch surgical technique for the management of massive postpartum hemorrhage (PPH) has been used successfully since 1989 in cases where bleeding was secondary to uterine atony with failed conservative management. It allows for conservation of the uterus for subsequent menstrual function and pregnancies. In this report, we present a follow up of a case with successful pregnancy ten years after PPH was managed with the B-Lynch uterine compression suture to demonstrate the long-term anatomical consequences of this operation. This case represents the longest follow up after the application of the B-Lynch suture (brace suture) technique for the control of massive PPH as an alternative to hysterectomy. Published data have confirmed that on the balance of probability, the B-Lynch surgical technique is safe, effective and free of short- and long-term complication.     

B-Lynch suture, intrauterine balloon, and endouterine hemostatic suture for the management of postpartum hemorrhage due to placenta previa accreta

Objective

To report our experience with a new conservative management approach to treat postpartum hemorrhage (PPH) due to placenta previa accreta.

Methods

A retrospective study of 9 patients with placenta previa accreta who underwent a conservative management protocol. The protocol consists of preventive radiological catheterization of the descending aorta, cesarean delivery, use of Affronti endouterine square hemostatic sutures, and placement of an intrauterine Bakri balloon in conjunction with B-Lynch suture. In the event of failure of the protocol, subsequent management employs ligation and/or reversible embolization of the uterine arteries followed by hysterectomy if unsuccessful.

Results

Conservative management of PPH was successful in all 9 patients evaluated and avoided the need for ligation and/or reversible embolization of the uterine arteries.

Conclusion

Management of PPH is dictated by several considerations including hemodynamic status and desire to preserve fertility. The initial results of this conservative protocol for treatment of PPH in high-risk patients with placenta previa accreta are encouraging.     

Single square hemostatic suture for postpartum hemorrhage secondary to uterine atony

Objective

The objective of this study is to describe a novel technique for the treatment of postpartum hemorrhage and evaluate its effectiveness and safety.

Methods

Single square hemostatic suture was performed for uterine atony when postpartum hemorrhage did not respond to medical therapy and bilateral uterine artery ligation. We retrospectively reviewed the data of 11 women and evaluated their endometrial cavity with hydrosonography after a follow-up period of 8–34 months.

Results

The single square hemostatic suture successfully stopped bleeding in all of the cases. Of the 11 women, 2 could not be traced. Menstruation started without delay in nine women. One of the women achieved pregnancy 25 months after surgery. The six women who underwent hydrosonography had an intact endometrial cavity.

Conclusions

For women who desire future fertility, and when bilateral uterine artery ligation is not sufficient to control PPH, single square suturing may be used as an effective and safe procedure.     

Postpartum hemorrhage and intrauterine balloon tamponade. A report of three cases

BACKGROUND: Postpartum hemorrhage can become rapidly catastrophic. If medical management fails, then, according to recent reports, the use of an intrauterine inflated Foley catheter balloon for tamponade gives excellent results and can help avoid invasive procedures. CASE: We present one case of profuse hemorrhage following evacuation of the fetus after intrauterine fetal death at 17 weeks' gestation controlled with intrauterine balloon tamponade and two cases of severe postpartum hemorrhage (one immediate and one late) following normal vaginal deliveries, both controlled with Foley catheters. In either case the patient required no blood transfusions, and major surgery was avoided. CONCLUSION: Intrauterine balloon tamponade is highly effective. The catheter is readily available, is not expensive, does not require special training for insertion and, extremely important, can avoid major surgery.     

宫腔填塞在产后出血的应用

在我国和大多数发展中国家,产后出血仍是孕产妇死亡的首位原因。发生产后出血时应尽快查明原因,积极综合治疗。本文主要阐述控制产后出血的保守治疗措施——宫腔填塞。通常是用纱布或球囊,尤其是近年来应用的Bakri球囊,放入子宫腔内起到止血作用,以减少子宫切除率。     

Uterine tamponade using condom catheter balloon in the management of non-traumatic postpartum hemorrhage

Aim: To study the efficacy and complications of uterine tamponade using condom catheter balloon in non-traumatic postpartum hemorrhage (PPH). Material and Methods: This prospective study was conducted in a tertiary care teaching hospital in India. Eighteen patients with non-traumatic PPH not responding to medical management were included in the study. Uterine tamponade was achieved by a condom catheter balloon filled with saline and kept in situ for 8-48?h. The main outcome measures were success rate in controlling hemorrhage, time required to stop bleeding, subsequent morbidity and technical difficulties. Data was analyzed using appropriate statistical methods. Results: The success rate of condom catheter balloon in controlling hemorrhage was 94%. The mean amount of fluid filled in the condom catheter balloon was 409?mL. The average time taken to control bleeding was 6.2?min. The mean duration for which condom catheter balloon was left in situ was 27.5?h. The average amount of blood loss was 1330?mL. Five patients (28%) had infective morbidity. Conclusion: Condom catheter balloon is effective in controlling non-traumatic PPH in 94% cases. It is effective, simple to use, easily available and is a cheap modality to manage non-traumatic postpartum hemorrhage, especially in limited resource settings.     

Comparing success rates of the Hayman compression suture and the Bakri balloon tamponade

Background: Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality around the world. Medical treatments and uterus-sparing interventions including balloon tamponades and compression sutures are the first line options before the decision is made to perform a hysterectomy. Our aim is to compare the success rates of the Hayman compression suture and the Bakri balloon tamponade (BBT) in patients with PPH.

Methods: We enrolled 82 patients who were diagnosed with uterine atony during their cesarean sections and failed to respond to uterotonic agents. The patients were treated with either a Hayman suture or a BBT.

Results: The success rates of the both methods were similar (76.7% in the Hayman group and 74.4% in the BBT group). In both groups, the success rate increased with the addition of artery ligations (93% in the Hayman group and 87.2% in the BBT).

Conclusion: The Hayman suture and the BBT’s performances were identical in the management of PPH due to uterine atony. All methods have pros and cons and the choice of the intervention depends on a variety of factors including the severity of bleeding, experience of the surgeon and the accessibility of the tools.     

The impact of Bakri balloon tamponade on the rate of postpartum hysterectomy for uterine atony

Objective: Our objective was to evaluate the impact of uterine tamponade with a Bakri balloon on the rate of postpartum hysterectomy due to uterine atony.

Methods: We performed a retrospective cohort study of all deliveries >20 weeks gestation from January 2002 to March 2013 at Baystate Medical Center. Charts were reviewed to determine incidence of postpartum hysterectomy, Bakri balloon placement, uterine artery embolization (UAE) and the B-Lynch procedure. Patients with evidence of placenta accreta were excluded. The primary outcome was the change in rates of postpartum hysterectomy for uterine atony before and after the introduction of Bakri balloon tamponade, using chi-square testing.

Results: There were 48?767 deliveries during the study period, with 17?950 before and 30?817 after the introduction of the Bakri balloon. A total of 43 Bakri balloons were placed during the study period and 21 hysterectomies were performed for postpartum hemorrhage secondary to uterine atony, 14 before and 7 after the introduction of the Bakri balloon. This was consistent with a decrease in the rate of postpartum hysterectomy from 7.8/10 000 deliveries to 2.3/10 000 deliveries (p?=?0.01).

Conclusion: Our findings show that utilization of the Bakri balloon is associated with a decreased rate of postpartum hysterectomy.