| Pelvic arterial ligations for severe post-partum hemorrhage. Indications and techniques. | |
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MedLine Citation:
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PMID: 21474415 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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O Morel; C Malartic; J Muhlstein; E Gayat; P Judlin; P Soyer; E Barranger |
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Publication Detail:
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Type: Journal Article; Review Date: 2011-04-07 |
Journal Detail:
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Title: Journal of visceral surgery Volume: 148 ISSN: 1878-7886 ISO Abbreviation: J Visc Surg Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-05-06 Completed Date: 2011-08-25 Revised Date: 2012-01-20 |
Medline Journal Info:
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Nlm Unique ID: 101532664 Medline TA: J Visc Surg Country: France |
Other Details:
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Languages: eng Pagination: e95-102 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Elsevier Masson SAS. All rights reserved. |
Affiliation:
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Service de gynécologie-obstétrique, hôpital Lariboisière, université Paris 7 Diderot, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France. olivier.morel17@gmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Female Humans Ligation / methods Postpartum Hemorrhage / surgery*, therapy Pregnancy Suture Techniques Uterine Artery / surgery* Uterine Artery Embolization Uterine Balloon Tamponade |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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