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Uterine-sparing surgical management of postpartum hemorrhage: is it always effective?
MedLine Citation:
PMID:  21932086     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: To further study the efficacy of uterine-sparing procedures based on triple uterine artery ligation (TUAL) possibly complemented with hemostatic multiple square suturing (HMSS) for the management of post-partum hemorrhage (PPH). METHODS: Cases of PPH occurring during cesarean section and treated, according to our institution guidelines, by TUAL possibly complemented with HMSS between 2000 and 2009 were retrospectively analyzed. RESULTS: Fifty-six patients were included; 13 (23.2%) had TUAL only, while 43 (76.8%) had additional HMSS performed. Surgical conservative management of PPH was effective in 51 (91.1%) cases. PPH due to placenta accreta, either unanticipated or after failure of conservative management, showed an independent and significant impact on the risk of failure of the procedure (AOR 15.07, 95% CI 1.12-201.9, p = 0.041). CONCLUSION: Obstetricians should be aware that a higher risk of failure of the procedure is to be expected in cases of PPH due to placenta accreta. In such situation, to avoid any useless delay in management, our findings suggest that peripartum hysterectomy should be immediately considered.
Authors:
Julie Blanc; Blandine Courbiere; Raoul Desbriere; Florence Bretelle; Léon Boubli; Claude D'Ercole; Xavier Carcopino
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-20
Journal Detail:
Title:  Archives of gynecology and obstetrics     Volume:  -     ISSN:  1432-0711     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8710213     Medline TA:  Arch Gynecol Obstet     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille (APHM), Hôpital Nord, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
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