Document Detail

Pelvic arterial ligations for severe post-partum hemorrhage. Indications and techniques.
MedLine Citation:
PMID:  21474415     Owner:  NLM     Status:  MEDLINE    
In cases of serious bleeding postpartum, resuscitation and surgical techniques are complementary and should be adapted to both the etiology and severity of bleeding. In extremely severe cases, the performance of a hysterectomy should not be delayed. For women with stable hemodynamic status, so-called "conservative" surgical techniques can instead be used. In this study, we describe and discuss the indications and feasibility of various techniques of vascular ligation. Uterine mattress suture compression techniques and abdomino-pelvic packing are also described. When conservative management is feasible, the first line approach should be bilateral distal ligation of the uterine arteries: this simple and low-risk technique is immediately effective in 80% of cases. If bleeding persists, uterine devascularization can be completed by a triple ligation as described by Tsirulnikov, with or without supplemental proximal ligation of the uterine arteries. This procedure should be performed in preference to the so-called "stepwise ligation sequence", which involves ligation of the ovarian pedicles and poses a risk of subsequent ovarian failure. Bilateral hypogastric artery ligation is also an effective and widely used first-line technique for experienced surgeons. This approach is technically challenging for less-experienced surgeons and is reserved for cases of failed triple ligation.
O Morel; C Malartic; J Muhlstein; E Gayat; P Judlin; P Soyer; E Barranger
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Publication Detail:
Type:  Journal Article; Review     Date:  2011-04-07
Journal Detail:
Title:  Journal of visceral surgery     Volume:  148     ISSN:  1878-7886     ISO Abbreviation:  J Visc Surg     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-05-06     Completed Date:  2011-08-25     Revised Date:  2012-01-20    
Medline Journal Info:
Nlm Unique ID:  101532664     Medline TA:  J Visc Surg     Country:  France    
Other Details:
Languages:  eng     Pagination:  e95-102     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Masson SAS. All rights reserved.
Service de gynécologie-obstétrique, hôpital Lariboisière, université Paris 7 Diderot, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
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MeSH Terms
Ligation / methods
Postpartum Hemorrhage / surgery*,  therapy
Suture Techniques
Uterine Artery / surgery*
Uterine Artery Embolization
Uterine Balloon Tamponade

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