Abstract
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.
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References
Ronsmans C, Graham WJ (2006) Maternal mortality: who, when, where, and why. Lancet 368:1189–1200
Deneux-Tharaux C, Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini A et al (2005) Underreporting of pregnancy-related mortality in the United States and Europe. Obstet Gynecol 106:684–692
Gissler M, Deneux-Tharaux C, Alexander S, Berg CJ, Bouvier-Colle MH, Harper M et al (2007) Pregnancy-related deaths in four regions of Europe and the United States in 1999–2000: characterisation of unreported deaths. Eur J Obstet Gynecol Reprod Biol 133:179–185
Philibert M, Boisbras F, Bouvier-Colle MH (2006) Epidemiology of maternal mortality in France from 1996 to 2002: frequency, risk factors and aetiologies. Bull Epidemiol Hebd 50:392–395
Prendiville W (1998) Active versus expectant management of third stage of labour. Lancet 351:1659
Begley CM, Gyte GM, Murphy DJ, Devane D, McDonald SJ, McGuire W (2010) Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 7:CD007412
Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L (2009) Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage. Obstet Gynecol 113:992–999
D’Ercole C, Shojai R, Desbriere R, Cravello L, Boubli L (2004) Surgical management of primary postpartum hemorrhage. J Gynecol Obstet Biol Reprod 33:4S103–4S119
Tsirulnikov MS (1979) Ligation of the uterine vessels during obstetrical hemorrhages. Immediate and long-term results (author’s transl). J Gynecol Obstet Biol Reprod 8:751–753
Doumouchtsis SK, Papageorghiou AT, Arulkumaran S (2007) Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv 62:540–547
Blanc J, Courbiere B, Desbriere R, Bretelle F, D’Ercole C, Boubli L et al (2011) Is uterine-sparing surgical management of persistent postpartum hemorrhage truly a fertility-sparing technique? Fertil Steril 95:2503–2506
Desbriere R, Courbiere B, Mattei S, Haumonte JB, Shojai R, Antonini F et al (2008) Hemostatic multiple square suturing is an effective treatment for the surgical management of intractable obstetric hemorrhage. Eur J Obstet Gynecol Reprod Biol 138:244–246
Provansal M, Courbiere B, Agostini A, D’Ercole C, Boubli L, Bretelle F (2010) Fertility and obstetric outcome after conservative management of placenta accreta. Int J Gynaecol Obstet 109:147–150
Cho JH, Jun HS, Lee CN (2000) Hemostatic suturing technique for uterine bleeding during cesarean delivery. Obstet Gynecol 96:129–131
AbdRabbo SA (1994) Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol 171:694–700
Sentilhes L, Trichot C, Resch B, Sergent F, Roman H, Marpeau L et al (2008) Fertility and pregnancy outcomes following uterine devascularization for severe postpartum haemorrhage. Hum Reprod 23:1087–1092
Belfort MA (2010) Placenta accreta. Am J Obstet Gynecol 203:430–439
Sentilhes L, Kayem G, Ambroselli C, Provansal M, Fernandez H, Perrotin F et al (2010) Fertility and pregnancy outcomes following conservative treatment for placenta accreta. Hum Reprod 25:2803–2810
Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F et al (2010) Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol 115:526–534
Bretelle F, Courbiere B, Mazouni C, Agostini A, Cravello L, Boubli L et al (2007) Management of placenta accreta: morbidity and outcome. Eur J Obstet Gynecol Reprod Biol 133:34–39
Carcopino X, D’Ercole C, Bretelle F (2009) Optimal management strategies for placenta accreta. BJOG 116:1538
Sentilhes L, Kayem G, Ambroselli C, Grange G, Resch B, Boussion F et al (2010) Placenta accreta: frequency, prenatal diagnosis and management. Presse Med 39:765–777
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Blanc, J., Courbiere, B., Desbriere, R. et al. Uterine-sparing surgical management of postpartum hemorrhage: is it always effective?. Arch Gynecol Obstet 285, 925–930 (2012). https://doi.org/10.1007/s00404-011-2083-7
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DOI: https://doi.org/10.1007/s00404-011-2083-7