Hemostatic cervical suturing technique for management of uncontrollable postpartum haemorrhage originating from the cervical canal

Transvaginally surgically treatment of early postpartum hemorrhage caused by lower uterine segment atony

OBJECTIVES

Prove the success of transvaginal hemostatic procedures in treatment of the early postpartum hemorrhage caused by lower uterine segment atony.

METHODS

We have conducted a retrospective, clinical study during a 10-year period (2010-2019) in our institution that is tertiary perinatal university center.

RESULTS

This particular study enrolled total number of 29,543 deliveries with 215 cases of early postpartum hemorrhage (0.72%). Lower uterine segment atony was diagnosed in 44 cases (29.93%) in all uterine atony cases of early postpartum hemorrhage. Hemostatic ligation procedures according to authors: Losickaja in two cases, Hebisch-Huch in 13 cases, Habek in seven cases, Hebisch-Huch + Losickaja in 10 cases. According to our results, hemostatic ligation procedures alone (32 cases; 72.72%) or combined with gauze or ballon tamponade (five cases, 11.36%), have shown to be highly effective in 37 cases (84.09%).

CONCLUSIONS

Lower uterine segment atony should definitely be identified and understood as a clinical entity. Transvaginal hemostatic approach for surgical treatment of lower uterine segment atony is accessible, minimally invasive, feasible, successful and lifesaving. All of the above-mentioned methods are of great importance in the prevention and treatment of obstetric shock, multiorgan failure, postpartum hysterectomy and finally vital for fertility preservation.

Incidence of postpartum post-cesarean hysterectomy at the Institute of gynecology and obstetrics, Clinical center of Serbia, Belgrade

Introduction. Postpartum hysterectomy means hysterectomy at least 6 weeks after delivery or cesarean section. It is usually performed in life-threatening situations. Incidence of postpartum hysterectomy varies from 0.02% to 0.3% of total number of deliveries. Objective. The aim of this study was to show and compare the incidence of postpartum hysterectomy after the cesarean section at the Institute of Gynecology and Obstetrics, Clinical Center of Serbia. We compared two five-year periods: the first period 1987-1982 and the second 2000-2004. Method. The retrospective study analyzed all patients treated at the Institute of Gynecology and Obstetrics who had had hysterectomy until six weeks after vaginal delivery or cesarean section. We analyzed the number of deliveries and the number of postpartum hysterectomies. Results. There were 50,467 deliveries (3,542 cesarean sections) and 91 postpartum hysterectomies (70 or 76.92% after cesarean section) in the first period. In the second period, there were 34,035 deliveries (7,105 cesarean sections) and 64 hysterectomies (39 or 60.94 % after cesarean section). The overall incidence of postpartum hysterectomy was 1.98/1,000 in the first and 1.88/1,000 deliveries in the second period. The incidence of post-cesarean hysterectomy decreased from 19.76/1,000 in the first period to 5.49/1,000 in the second period. Conclusion. It is crucial for each obstetrician to cautiously distinguish and reach an appropriate decision about the exact indications for cesarean delivery having in mind growing incidence of cesarean sections, which is the main risk factor for puerperal morbidity and mortality. .