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1.
Medicine (Baltimore) ; 98(44): e17742, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689824

RESUMO

Placenta previa and accreta with prior cesarean section is an extremely serious condition that is associated with maternal morbidity and mortality from obstetric hemorrhage. The aim of our study was to evaluate the efficacy and advantages of a novel surgical technique, parallel transverse uterine incisions (PTUI), during conservative cesarean delivery in patients with placenta previa and accreta.This was a retrospective cohort study including 124 pregnant women, who had at least 1 prior cesarean section and were diagnosed with anterior placenta previa and accreta between January 2014 and October 2017. Using the hospital's information system, patients were retrospectively classified into undergoing either the PTUI surgery (Group A) or the ordinary cesarean section (Group B). Surgical outcomes and maternal complications during hospitalization were collected. The results from 2 groups were compared and analyzed statistically. Multivariable regression analyses were further used to assess the effect of PTUI on severe maternal outcomes.Patients who underwent PTUI were not statistically different from patients who underwent the ordinary cesarean section in terms of maternal and infants' characteristics. However, PTUI was associated with remarkably reduced intraoperative blood loss (P = .005), related vaginal blood loss after surgery (P = .026), and transfusion requirement of packed red cells (P = .000), compared to the ordinary cesarean section. Moreover, cesarean hysterectomy (3.3% vs 21.9%; P = .002) and intensive care unit admission (1.7% vs 29.7%; P = .000) were significantly fewer among patients who underwent PTUI. Multivariable regression analyses further showed that the risk of intraoperative hemorrhage (ß = -2343.299, P = .000) and cesarean hysterectomy (odds ratio = 0.027, P = .018) were both significantly decreased by PTUI.PTUI is a novel approach that may significantly reduce maternal complications, while preserving the uterus for patients with anterior placenta previa and accreta.


Assuntos
Cesárea/métodos , Histerectomia/métodos , Histeroscopia/métodos , Tratamentos com Preservação do Órgão/métodos , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Transfusão de Sangue/estatística & dados numéricos , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia/efeitos adversos , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Útero/cirurgia
3.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31473635

RESUMO

A gravida 4 para 1021, 41-year-old woman postcaesarean section at 39 weeks and 1 day with clinically significant haemorrhage required embolisation of unique uterine arterial collaterals. She had persistent haemorrhage after initial bilateral uterine artery embolisation, and on further investigation she was found to have a hypertrophied right round ligament artery. Once successful embolisation of this abnormal right round ligament artery was completed using a combination of Gelfoam and coils, haemostasis was achieved. She had rapid clinical improvement, no complications and no further admissions on postprocedural follow-up over a year and a half later.


Assuntos
Hemorragia Pós-Parto/cirurgia , Ligamento Redondo do Útero/irrigação sanguínea , Embolização da Artéria Uterina/métodos , Artéria Uterina/patologia , Adulto , Feminino , Humanos , Hipertrofia , Gravidez , Ligamento Redondo do Útero/cirurgia , Artéria Uterina/cirurgia
4.
A A Pract ; 13(7): 264-266, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31206379

RESUMO

Postpartum hemorrhage is a leading cause of maternal and fetal mortality. Although rare, peripartum splenic rupture (PSR) is a lethal cause of bleeding due to variable presentation and delayed diagnosis. A 22-year-old gravida 2, para 0, abortus 1 (G2P0A1) woman presented for premature rupture of membranes and was diagnosed with Influenza A and chorioamnionitis. She underwent emergent cesarean delivery under general anesthesia. Postoperatively, her condition worsened despite treatment for presumed sepsis. She was taken to the operating room for an exploratory laparotomy, and a splenectomy was performed for splenic rupture. We discuss management, risk factors, challenges, and importance of prompt treatment of PSR.


Assuntos
Cesárea/efeitos adversos , Ruptura Prematura de Membranas Fetais/cirurgia , Hemorragia Pós-Parto/etiologia , Ruptura Esplênica/diagnóstico , Corioamnionite/diagnóstico , Tratamento de Emergência , Feminino , Humanos , Vírus da Influenza A/isolamento & purificação , Influenza Humana/diagnóstico , Hemorragia Pós-Parto/cirurgia , Gravidez , Esplenectomia , Ruptura Esplênica/complicações , Ruptura Esplênica/cirurgia , Adulto Jovem
6.
Int J Gynaecol Obstet ; 146(1): 103-109, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31055843

RESUMO

OBJECTIVE: To determine incidence, risk indicators, and outcomes of emergency peripartum hysterectomy (EPH) in Metro East, Cape Town, South Africa. METHODS: A population-based district-wide prospective descriptive study of EPH in public hospitals from November 2014 to November 2015. Women were enrolled by using the WHO maternal near miss tool and followed until discharge. EPH was defined as hemorrhage or infection leading to hysterectomy during pregnancy or within 42 days of delivery. RESULTS: Fifty-nine women experienced EPH with an overall incidence of 14.3 per 10 000 women: 32 procedures were for postpartum hemorrhage, 27 for puerperal sepsis. Two women died: one from sepsis; one from hemorrhage. Overall, 51 (86%) women delivered by cesarean, and 23/51 (45%) by repeat cesarean. As compared with hemorrhage, EPH for sepsis involved older women (mean age, 31.5 vs 24.4 years) and those with higher gravidity (median, 3 vs 1), and was associated with longer hospital admission (median, 11.5 vs 4 days), with occurrence later postpartum (median, 8 vs 0 days), and more frequently with complications. CONCLUSIONS: The incidence of EPH for sepsis was higher than previously reported. Repeat cesarean was strongly associated with EPH. Clinical characteristics of sepsis-related EPH compared unfavorably with those of hemorrhage-related EPH.


Assuntos
Histerectomia/estatística & dados numéricos , Hemorragia Pós-Parto/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Sepse/epidemiologia , Adulto , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Incidência , Mortalidade Materna , Período Periparto , Hemorragia Pós-Parto/cirurgia , Gravidez , Complicações Infecciosas na Gravidez/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Sepse/cirurgia , África do Sul/epidemiologia , Adulto Jovem
8.
J Obstet Gynaecol ; 39(5): 601-605, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30821181

RESUMO

This retrospective study evaluates the effects of a massive postpartum haemorrhage (PPH) on maternal outcomes in an inner-city London hospital. One hundred and eighty-four cases of a massive primary PPH (>2000 mL) were identified over a seven-year period. A sub-group analysis was performed to assess whether 2000-3000 mL blood loss (134 cases) was associated with specific maternal characteristics or reduced adverse outcomes compared with >3000 mL blood loss (50 cases). Bakri balloon tamponade (BBT) was the most frequent form of surgical management in both groups (21 vs. 46%), followed by compression sutures (16.4 vs. 24%), the 'uterine sandwich' technique (6.7 vs. 14%) and the hysterectomy (0 vs. 4%). There were significant differences between these groups in placenta praevia as the cause of blood loss (8 vs. 22%, p = .01), length of stay (4.6 vs. 5.9 d, p = .02), use of BBT (p = <.01) and hysterectomy (p = .03). PPH is associated with premature maternal morbidity and mortality. The incidence is increasing in high income countries despite various guidelines, skills training and identification of risk factors. A prediction and assessment of blood loss remain the very cornerstone for a prompt, effective management. Our study shows that the morbidity is clearly related to the amount of blood loss and highlights the existing variable practices for the management of PPH. Impact statement What is already known on this subject? A postpartum haemorrhage (PPH) remains a common cause of maternal morbidity and mortality. Massive PPH (>2000 mL) rates continue to rise in developed countries. The management of PPH includes the medical treatment followed by surgical methods including the Bakri balloon tamponade (BBT), compression sutures or a hysterectomy. What do the results of this study add? This retrospective study evaluates the effects of a massive PPH (blood loss >2000 mL) on maternal outcomes. One hundred and eighty-four cases of a massive PPH were identified over a seven-year period. Sub-group analysis was performed to assess whether a 2000-3000 mL blood loss was associated with specific maternal characteristics and differences in obstetric practice compared with a >3000 mL blood loss. There were significant differences between these groups in placenta praevia, as the cause of blood loss, the length of stay, the use of BBT and the hysterectomy rates. What are the implications of these findings for clinical practice and/or further research? An early identification of the risk factors of a massive PPH is essential to improve maternal outcomes and is an important part of the antenatal, intrapartum and postpartum period. The prediction and assessment of blood loss remain key for a prompt, effective management. The amount of blood loss is related to adverse maternal outcomes and the management techniques applied. BBT has an essential role to play and should be included as part of the core training in the management of a PPH.


Assuntos
Hemorragia Pós-Parto/cirurgia , Resultado do Tratamento , Descolamento Prematuro da Placenta , Adulto , Índice de Massa Corporal , Feminino , Hospitais Universitários , Humanos , Histerectomia , Londres , Placenta Prévia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/mortalidade , Gravidez , Estudos Retrospectivos , Técnicas de Sutura , Tamponamento com Balão Uterino/métodos , Inércia Uterina , Ferimentos e Lesões/complicações
9.
BMC Pregnancy Childbirth ; 19(1): 91, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30866846

RESUMO

BACKGROUND: Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and one of the leading causes of maternal mortality worldwide. Many medical treatments and interventions are available nowadays, but surgical treatment is sometimes required when less invasive methods are unsuccessful. This study aimed to assess the theoretical and practical knowledge of French residents of Obstetrics and Gynecology concerning the surgical treatment of postpartum haemorrhage. STUDY DESIGN: We performed a questionnaire study for senior residents of Obstetrics and Gynecology in France (fourth and fifth year of training). An anonymous survey was sent by email. Between December 2013 and April 2014, a total of 370 residents responded. RESULT: The response rate was 47.6% (176/370). Only 156 questionnaires were fully completed and included for analysis. In all, 74% (115/156) of residents reported not mastering sufficiently or at all the technique for bilateral ligation of uterine arteries, 79% (123/156) for uterine compression sutures, 95% (148/156) for ligation of the internal iliac arteries, and 78% (122/156) for emergency peripartum hysterectomy. More than half of respondents (55%, 86/156) stated that they had not mastered any of these techniques. CONCLUSION: An alarmingly high number of French senior residents in Obstetrics and Gynecology report that they have not acquired the sufficient surgical skills during their training to be able to perform the surgeries required for the management of PPH.


Assuntos
Competência Clínica/estatística & dados numéricos , Ginecologia/educação , Conhecimentos, Atitudes e Prática em Saúde , Internato e Residência/estatística & dados numéricos , Obstetrícia/educação , Hemorragia Pós-Parto/cirurgia , Adulto , Feminino , França , Humanos , Histerectomia , Artéria Ilíaca , Ligadura , Masculino , Inquéritos e Questionários , Artéria Uterina
10.
BMC Surg ; 19(1): 33, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30866898

RESUMO

BACKGROUND: We developed a dedicated blunt straight needle with No. 2 polydioxanone sutures (2-Monodiox®) for uterine compression sutures (UCSs) and aimed to assess the outcomes and complication rates of UCSs for postpartum hemorrhage by comparing with commercially available needle and suture types. METHODS: A retrospective analysis was performed between January 2010 and February 2018. During the study period, two types of commercially available sutures and 2-Monodiox® were used. PubMed, MEDLINE, and Scopus databases were searched for English articles published between January 1997 and May 2017 using search terms related to the suture and needle types for UCSs to discuss the dedicated needles and sutures for UCS. RESULTS: The analysis included 47 cases of UCSs for the uterine body with three suture types (No. 0 polydioxanone, 7 cases; No. 1 poliglecaprone 25, 21 cases; and No. 2 polydioxanone, 19 cases). B-Lynch suture using No. 0 sutures was associated with a significantly lower uterine preservation rate than those with Nos. 1 and 2 sutures (42.9% vs. 95.2 and 89.5%, respectively; p < 0.01). A modified Hayman suture technique was performed using 2-Monodiox® sutures, which achieved a similar uterine preservation rate compared with B-Lynch suture using No. 1 poliglecaprone 25 sutures. No patients developed severe complications. The literature review showed that no dedicated sutures have developed for UCSs. Three dedicated needles for UCSs have been developed, and 2-Monodiox® is the first dedicated blunt straight needle for UCSs. CONCLUSION: Our data showed that No. 0 sutures should not be used for B-Lynch suture. The uterine preservation rate is similar for 2-Monodiox® with modified Hayman suture and No. 1 poliglecaprone 25 sutures with B-Lynch suture, without the occurrence of severe complications.


Assuntos
Agulhas , Hemorragia Pós-Parto/cirurgia , Técnicas de Sutura/instrumentação , Útero/cirurgia , Adulto , Feminino , Humanos , Polidioxanona , Estudos Retrospectivos , Suturas
11.
Int J Gynaecol Obstet ; 145(2): 244, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30737983

RESUMO

More than 30 uterine compression sutures have been reported; a classification system is urgently needed.


Assuntos
Hemorragia Pós-Parto/cirurgia , Feminino , Humanos , Morbidade , Gravidez , Técnicas de Sutura , Suturas , Útero/cirurgia
12.
Taiwan J Obstet Gynecol ; 58(1): 72-76, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30638485

RESUMO

OBJECTIVE: This study aimed to report our experience of emergent bilateral hypogastric (internal iliac) artery ligation (HAL) in the management of intractable postpartum hemorrhage (PPH) in a tertiary care center. MATERIALS AND METHODS: Patients with severe postpartum hemorrhage that could not be controlled with conservative management were retrospectively reviewed from January 2013 to December 2017. Data were retrieved from patients' hospital records. Two cases involving both transcatheter uterine artery embolization (TAE) and HAL were excluded. A total of 40 patients were included in the analysis during this period. The inclusion criteria were gestational age ≥24 weeks and primary severe PPH (blood loss ≥1500 mL within 24 h after birth). RESULTS: A total of 40 patients with intractable PPH were included after a thorough review of their medical records. Nine of them required HAL during the study period. Causes of PPH included uterine atony, placental abruption, vaginal/cervical laceration, uterine rupture, and placenta accreta. Hemorrhage was effectively controlled in 8 of 9 patients (88.9%) in the group undergoing bilateral HAL even though their initial conditions were poor. All patients with HAL did not have to undergo hysterectomy. No immediate complications developed. There were two maternal deaths in the group undergoing TAE. CONCLUSION: Bilateral HAL is an effective life-saving procedure for severe intractable PPH and should be performed as soon as possible when obstetric emergency conditions are indicated.


Assuntos
Artéria Ilíaca , Ligadura/métodos , Hemorragia Pós-Parto/cirurgia , Embolização da Artéria Uterina/métodos , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária
14.
BJOG ; 126(3): 412-417, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30009547

RESUMO

Postpartum haemorrhage (PPH), especially resulting from placenta accreta spectrum (PAS), has become a worldwide concern in maternity care. We describe a novel method of uterine compression sutures (the 'Nausicaa' technique) as an alternative to hysterectomy for patients who have suffered from major PPH. We applied this technique in 68 patients with major PPH during caesarean section (including 43 patients with PAS, 20 patients with placenta praevia totalis, and five patients with uterine atony), and none of these patients required further hysterectomy. We conclude that our Nausicaa suture is a simple and feasible alternative to hysterectomy in patients suffering from major PPH.


Assuntos
Cesárea , Placenta Acreta , Placenta Prévia , Hemorragia Pós-Parto/cirurgia , Técnicas de Sutura , Inércia Uterina , Adulto , Feminino , Humanos , Histerectomia , Massagem , Pessoa de Meia-Idade , Misoprostol/uso terapêutico , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/terapia , Gravidez , Índice de Gravidade de Doença , Falha de Tratamento , Adulto Jovem
15.
J Perinat Med ; 47(2): 169-175, 2019 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-30179854

RESUMO

Background Peripartal hysterectomy (PH) is a challenging surgical procedure with elevated maternal morbidity. Methods From 2004 to 2016, 41 emergency PHs were performed at the tertiary care center of the Department of Gynecology and Obstetrics at University Hospital Ulm. In our retrospective analysis, the incidence of PH in our hospital was 12.8 per 10,000 deliveries with a maternal mortality of 2.4%. PH followed in 80.5% after cesarean section (c-section). Underlying causes/indications for PH were abnormal placentation (53.7%; n=22), uterine atony (26.8%; n=11), uterine lacerations (14.6%; n=6) and in rare cases uterine infection (4.9%; n=2). The median number of transfused products was 11 packed red blood cells (range 0-55 products), 10 fresh frozen plasma units (range 1-43) and two platelet concentrates (0-16). Results Loss of blood as estimated by surgeons was significantly correlated with actual transfused blood volume (P<0.001). Clinically relevant intra- and/or postoperative complications occurred in 53.7% of patients (n=22). Abnormal placentation was the leading cause for PH with an increased incidence during the last 10 years presumptively representing the elevated rate of c-sections. Conclusion PH goes along with increased rates of blood product transfusions independently of indication for surgery and has a high morbidity with a major complication rate of more than 50%. Prepartal assessment of risk factors like abnormal invasive placenta are crucial for reducing maternal morbidity.


Assuntos
Cesárea , Histerectomia , Complicações Pós-Operatórias , Adulto , Transfusão de Sangue/métodos , Transfusão de Sangue/estatística & dados numéricos , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Histerectomia/mortalidade , Incidência , Mortalidade , Assistência Perinatal/métodos , Assistência Perinatal/estatística & dados numéricos , Doenças Placentárias/epidemiologia , Doenças Placentárias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/cirurgia , Gravidez , Medição de Risco , Fatores de Risco , Inércia Uterina/epidemiologia , Inércia Uterina/cirurgia , Ruptura Uterina/epidemiologia , Ruptura Uterina/cirurgia
16.
Arch Gynecol Obstet ; 299(1): 113-121, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30357496

RESUMO

AIMS: The aims of this study were to clarify: (i) the effectiveness of Matsubara-Yano uterine compression suture (MY) to achieve hemostasis in the presence of postpartum hemorrhage (PPH) during cesarean section, (ii) the type of PPH for which MY is effective, (iii) post-operative complications of MY, and (iv) outcomes of pregnancy after MY. METHODS: This retrospective observational study was performed using medical records of patients for whom MY had been performed between January 1, 2009 and December 31, 2017. RESULTS: MY was performed for 50 patients, with hemostasis achieved in 46 (92%). The other four (8%: 4/50) patients required transarterial embolization or hysterectomy. Of these four, three patients had placenta accreta spectrum (PAS) disorder-related bleeding. Post-operative complications were observed in three (6%: 3/50) patients, with all showing intrauterine infection. All three patients recovered solely with antibiotics. Eight pregnancies were confirmed (five livebirths, two spontaneous abortions in the first trimester, and one case of ongoing pregnancy). Of the five livebirths, one resulted in cesarean hysterectomy due to placenta previa with PAS disorders. CONCLUSIONS: MY had a hemostatic effect on PPH. All cases except one with hemostatic failure were associated with PAS disorders, indicating that the hemostatic rate was lower in those with PAS than non-PAS disorders.


Assuntos
Cesárea/efeitos adversos , Hemostasia Cirúrgica/métodos , Hemorragia Pós-Parto/cirurgia , Técnicas de Sutura , Adulto , Feminino , Humanos , Histerectomia/efeitos adversos , Japão , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/etiologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Suturas/efeitos adversos , Resultado do Tratamento , Embolização da Artéria Uterina , Útero/cirurgia
17.
J Minim Invasive Gynecol ; 26(4): 760-765, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30366116

RESUMO

Hemorrhage after gynecologic surgery is an infrequent complication. It can be divided based on time of onset into primary and secondary. Secondary hemorrhage is a life-threatening complication with a reported incidence of .17% to .45%. When the etiology cannot be ascertained and when the hemorrhage does not respond to conservative management, it is aptly labeled as an intractable hemorrhage. Numerous techniques have been used to manage secondary hemorrhage, including vaginal exploration and securing of the bleeding vessels, laparotomy and ligation of uterine and internal iliac arteries, and transarterial embolization of uterine or internal iliac vessels using interventional radiologic modalities. Circumferential vault excision and reconstruction is a methodic technique to effectively control this condition using a total laparoscopic route with systematic and easily replicable steps.


Assuntos
Histerectomia/efeitos adversos , Histerectomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Hemorragia Pós-Parto/cirurgia , Útero/irrigação sanguínea , Vagina/cirurgia , Embolização Terapêutica , Feminino , Humanos , Artéria Ilíaca/cirurgia , Laparoscopia , Ligadura , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares
18.
Arch Gynecol Obstet ; 299(1): 135-139, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30386992

RESUMO

PURPOSE: The purpose of this study was to evaluate the effectiveness of intrauterine continuous running suture during cesarean section in pregnant women with placenta previa. METHODS: We enrolled 277 women and medical records were retrospectively reviewed. Pregnant women were grouped according to uterine bleeding control methods as follows: Group A, using intrauterine continuous running suture and Group B (control group) using figure-of-eight suture. RESULTS: Intrauterine continuous running sutures were used in 104 pregnant women. Mean total blood loss in Group A was significantly less than that in Group B (1332.70 ± 152.92 mL vs 1861.56 ± 157.74 mL, P = 0.029). Mean total transfusion unit of Group A was significantly less than that in Group B (1.74 ± 0.41 vs 3.52 ± 0.75, P = 0.037). CONCLUSIONS: Intrauterine continuous running sutures can significantly reduce postpartum blood loss and transfusion units during cesarean section in pregnant women with placenta previa.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea , Placenta Acreta/cirurgia , Placenta Prévia/terapia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/cirurgia , Técnicas de Sutura , Artéria Uterina/cirurgia , Adulto , Transfusão de Sangue , Cesárea/efeitos adversos , Cesárea/métodos , Feminino , Humanos , Estudos Longitudinais , Placenta Prévia/diagnóstico , Placenta Prévia/cirurgia , Gravidez , Estudos Retrospectivos , Suturas , Resultado do Tratamento
20.
Semin Perinatol ; 43(1): 27-34, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30578144

RESUMO

When medical management of PPH is unsuccessful, surgical options should be utilized in a timely fashion in order to reduce maternal morbidity and mortality. This chapter describes ways of effective preparation, mobilization of resources and an organized approach to evaluation and surgical amelioration of PPH. Multiple fertility preserving surgical techniques to control PPH are described. Although a variety of conservative surgical approaches can be used in the setting of PPH, in a hemodynamically unstable patient, readiness for definitive management with a hysterectomy is necessary in order to reduce the risk of maternal mortality.


Assuntos
Preservação da Fertilidade/métodos , Histerectomia/métodos , Hemorragia Pós-Parto/cirurgia , Embolização da Artéria Uterina/métodos , Útero/cirurgia , Feminino , Guias como Assunto , Humanos , Tratamentos com Preservação do Órgão , Seleção de Pacientes , Gravidez
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