G Ducarme1, S Bargy, A Grossetti, B Bougeois, M Levardon, D Luton. 1. Service de chirurgie gynécologique et d'obstétrique, hôpital Beaujon, AP-HP, université Paris-7, 100, boulevard du Général-Leclerc, 92110 Clichy, France. g.ducarme@gmail.com
Abstract
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.
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.