Risk of synechiae following uterine compression sutures in the management of major postpartum haemorrhage.

OBJECTIVE: To determine with hysteroscopy or hysterosalpingogram the risk of uterine synechiae following uterine compression sutures for major postpartum haemorrhage (PPH) caused by uterine atony. DESIGN: A retrospective observational study. SETTING: Department of Obstetrics and Gynaecology, Beaujon Hospital, Clichy, France. POPULATION: One hundred and ninety-seven women with PPH between 2007 and 2010. One hundred and thirteen women (57.4%) were transferred as an emergency to our institution from other centres. METHODS: Of the 197 women, 94 with PPH had uterine arterial embolisation and 33 with major PPH were managed with surgical uterine compression sutures (Hackethal technique). The women were invited to undergo a control hysteroscopy or hysterosalpingogram, after postpartum consultation, to assess the uterine cavity. MAIN OUTCOME MEASURE: The prevalence of subsequent uterine synechiae. RESULTS: Uterine compression sutures succeeded in controlling PPH in 26 of 33 women (78.8%). Seven needed a hysterectomy. Among women with a preserved uterus, 15 underwent an exploration of the uterine cavity, including hysteroscopy (12) or hysterosalpingogram (8). Four women (26.7%) developed uterine synechiae and one had a subsequent pregnancy 18 months after uterine compression sutures. The median time between delivery and hysteroscopy or hysterosalpingogram was 9.3 months (2.4-34.8 months). CONCLUSIONS: This study suggests a significant risk of uterine synechiae after placement of compression sutures for PPH that transverse the uterine cavity. Postoperative uterine synechiae might be underestimated, and their prevalence and clinical significance should be assessed in long-term follow-up studies.

[Surgical management of peripartum hemorrhage: a retrospective study]. / Prise en charge chirurgicale des hémorragies de la délivrance: étude rétrospective.

OBJECTIVE: Peripartum haemorrhage is an obstetrical emergency and requests a life saving procedure. The purpose of this study is to describe our experience with the surgical management of peripartum haemorrhage. PATIENTS AND METHODS: We performed a retrospective study including 16 patients who necessitated a surgical management of peripartum haemorrhage (artery ligations, uterine compression and/or emergency peripartum hysterectomy) between 1985 and 2007. RESULTS: The incidence of surgical management of peripartum haemorrhage was 0.047%. Conservative surgical management consisted in uterine compression sutures in three cases. Artery ligations were performed without success in seven patients; only one case of isolated utero-ovarian artery ligations was effective. An emergency peripartum hysterectomy was necessary in 12 cases. Uterine atony was the principal etiologic factor (43.8% of cases). There were no significant perioperative complications. No maternal death was reported. DISCUSSION AND CONCLUSION: In cases of non life-saving procedure, medical treatment and uterine arteries embolisation are often sufficient. Uterine compression suturing techniques are interesting alternatives and uterine arteries ligations can always be performed before hysterectomy. In cases of failure of conservative treatment, the emergency peripartum hysterectomy must be performed. Then, the choice concerning the surgical technique for the management of peripartum haemorrhage may be adapted to the patient, the centre and the obstetrical team.

[Surgical management of stress urinary incontinence: a questionnaire-based survey amongst members of the Société de Chirurgie Gynécologique et Pelvienne (SCGP)]. / Prise en charge chirurgicale de l'incontinence urinaire d'effort : résultat d'une enquête par questionnaire parmi les membres de la Société de chirurgie gynécologique et pelvienne (SCGP).

OBJECTIVE: To evaluate by voluntary and anonymous declaration the current surgical practice for female stress urinary incontinence (SUI) in France. POPULATION AND METHODS: A postal survey, anonymous, sealed, and validated by the Scientific Committee of the Société de chirurgie gynécologie et pelvienne (SCGP), was conducted among all members. The questionnaire was also available online, on the SCGP website. RESULTS: One hundred and three (18%) members responded. The respondents (87%; n=90) were performing less than 10 incontinence procedures in a month. Suburethral slings represent the choice technique for SUI, prior by transobturator approach (87%; n=90). Other practices are exceptional. Urodynamics study was routinely performed prior to surgery in 69% of cases. Surgical treatment was performed using prior regional anaesthesia in retropubic approach (58%; n=40 in 68 respondents); either loco-regional (47%; n=48 in 102 respondents) or general anaesthesia (50%; n=51 in 102 respondents) were used in transobturator approach. No transobturator route was privileged. The postoperative urethral catheter was being left for 24h or less in case of retropubic or transobturator approach (70%; n=37 in 53 respondents and 68%; n=52 in 76 respondents, respectively). The patient's hospital stay was one night (83%; n=54 in 65 respondents and 85%; n=87 in 102 respondents, respectively). A postoperative audit was not done by 19% of respondents. DISCUSSION AND CONCLUSION: Suburethral tape placement is nowadays the main surgical treatment for female stress urinary incontinence amongst members of SCGP. The transobturator approach is preferred.

[Continuous medical evaluation in a gynaecological and obstetrical unit: Our experience about scheduled caesarean]. / Evaluation des pratiques professionnelles dans le cadre de la certification d'un établissement public de santé à propos des césariennes programmées.

Continuous medical evaluation (CME) is compulsory which aims to ameliorate and guarantee quality of care. This paper describes the experience of our unit during the different stages of evaluation that permit us to obtain our accreditation. Our evaluation dealt with the "amelioration of women's and newborn's care after scheduled caesarean section". A first retrospective study of files of scheduled caesareans allowed to update possible points of improvement, after application of adapted corrective actions, both at the medical and paramedical level. The second study, made after application of these actions, allowed to appreciate the results of our initiative of CME, to update new possible points of improvement, but also to notice certain limits in the achievement of the objectives.