Jurnalul de Chirurgie
 Jurnalul de chirurgie
Aparitie trimestriala in a doua luna a trimestrului
Published quarterly in the second month of the quarter
ISSN: 1584 - 9341 Vol.10 Nr.3 - Iulie-Septembrie 2014 | miercuri, 21 august 2019
ISSN: 1584 - 9341 Vol.10 No.3 - July-September 2014
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POSTPARTUM HEMORRHAGE - A REVIEW
I. Marcovici
Department of Obstetrics and Gynecology, Yale University, New Heaven CT
Department of Obstetrics and Gynecology, Connecticut University, Farmington, CT
Jurnalul de chirurgie 2005; 1 (4):383-389
Full text: Format PDF (English)

Postpartum hemorrhage has been defined as either a 10% change in hematocrit between admission and postpartum period or a need of erythrocyte transfusion. The incidence of postpartum hemorrhage is 3.9% for vaginal deliveries and 6.4% for cesarean delivery. Clinically the blood loss is often underestimated by as much as 30% - 50% resulting in a delay in addressing the problem. Postpartum hemorrhage can become rapidly catastrophic.

The ACOG ranks postpartum hemorrhage as the third cause of maternal mortality after embolism and hypertensive disease. Predisposing factors for postpartum hemorrhage are: uterine atony (50%), lower genital tract lacerations (20%), uterine abnormalities (20%) etc. Management of the postpartum hemorrhage includes a rapid but thorough physical examination, specifically of the abdominal and pelvic regions, concurrent with laboratory evaluation and volume replacement therapy. Coagulation studies are also necessary.

If no genital tract lacerations are found, some maneuvers must be done: uterine exploration followed by uterine massage and blunt curettage, if the products of conception are found in the uterine cavity. If postpartum hemorrhage is due to uterine atony then, uterotonic regimens should be used (methyl-ergonovine, 15-methyl prostaglandin F2 (alpha), prostaglandin E2 or misoprostol). When all other conservative methods of treatment of postpartum hemorrhage failed, before going for invasive procedures as uterine embolization and laparotomy, I strongly suggest the use of Intrauterine Balloon Tamponade.

Invasive procedures comprise embolization and laparotomy with conservative techniques (ligation of the uterine blood supply and uterine compression sutures) or hysterectomy or/and Transvaginal Pressure Pelvic Pack.

In conclusion, post-partum hemorrhage can become rapidly catastrophic. Once the diagnosis is made, a quick and methodic approach to the problem, following the algorithm bellow, can be very helpful. Also, remember the intrauterine balloon tamponade: very effective, does not require specialized training, it is easy to use and readily available in OR (operating room) and in my opinion it is underutilised.

KEYWORDS: POSTPARTUM HEMORRHAGE, INTRAUTERINE BALLOON TAMPONADE, EMBOLISATION, HYSTERECTOMY, TRANSVAGINAL PRESSURE PELVIC PACK

Correspondence:



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Jurnalul de chirurgie [Journal of Surgery] by Editorial Board, Department of Surgery University of Medicine and Pharmacy Iasi, E. Tarcoveanu, R. Moldovanu is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Based on a work at www.jurnaluldechirurgie.ro.