Uterine Compression Sutures for Postpartum Bleeding With Uterine Atony (WITH FLASH)

7/25/2019 Uterine Compression Sutures for Postpartum Bleeding With Uterine Atony (WITH FLASH)

1/40

Uterine Compression Sutures forPostpartum Bleeding with Uterine Atony

J Cuahba, M Piketty, C Huel,

M Aarian, ! "eraud, # $uton,

! Sibony, J" !ury

British Journal of Obstetrics and Gynaecology 2007; Vol 114


2/40


Introduction

Postpartu

!aeorrhage

"aternal

orbidity"aternal

ortality


3/40


Comlications

Initial management is ESSENTIAL

Hypovolemic

shock

DIC

Multiorgan

failure

PP!


4/40

British Journal of Obstetrics and Gynaecology !!"# $ol %%&

Angiographi%emboliation

Uterotoni%agents

Uterinemassage

Bimanual%ompression

Bleeding secondary to uterine atonyBleeding secondary to uterine atony


5/40

British Journal of !bstetri%s and &ynae%ology '(()* +ol -

Introduction

'sual methods

failed

#$%G&%'


6/40


#urgical techni(ues )

Compression sutures of the uterus

Haemostatic hysterectomy


7/40


(o assess the efficacy of the ne) uterine

compression suturing techni*ue in reducingpostpartum haemorrhage secondary to severe

uterine atony

Ob*ecti+e


8/40


+obert Debre Hospital, a university hospital

of -aris, .rance December !!! until March !!/

#etting


9/40British Journal of Obstetrics and Gynaecology 2007; Vol 114

Material & Methods

-ersistent uterine atony

$terine assage

O,ytocin perfusion

intrauterine in*ection of o,ytocin

-ntra+enous sulpostrone

.O"P%#-O/ #$$%


10/40

Characteristics

Age '. / -( y

Parity

Primiparous

Multiparous 0

S1C history .

Pregnan%y

Singleton 2

3win -

Hb 42 g1dl 504- / -6

&estational age .7,) w 5.-4 / -4-6

#eli8ery

Caesarean se%tion )

9on progressi8e labour

"etal heart rate anomaly .

Pla%enta prae8ia '


11/40

!terine comression sutures

"laced by the same oerator"fannenstiel#s incision $ uterus

e%teriorised&fter bimanual comression for a fe'

minutes( 4 trans)erse uterinecomression sutures 'ere laced*ynthetic multifilament absorbsable

suture+o fasilitate stitching( uterine 'alls

'ere comressed to reduce theirthic,ness



12/40


+he needle 'as inserted through theserosa of anterior 'all into serosa of

osterior 'all&nother suture oint - cm from the1st .oined from osterior to anterior'all

& flat double ,not 'as tied on theanterior 'all as tighly as ossible



13/40British Journal of !bstetri%s and &ynae%ology '(()* +ol -

UTERINE COMPRESSION SUTURES

4 #utures

"iddle of the fundus

oer segent

&ach horn

3inal result


14/40

$terine copression sutures


% minutes )ere re*uired(he success of the procedure is immediately

visibleIn the event of failure 0 persistenthaemorrhage artery ligationhysterectomy


15/40British Journal of Obstetrics and Gynaecology 2007; Vol 114

ResultsC12 $aginal delivery

%'terine atony 0-ostpartum bleeding

Compression

sutures

$ascular ligation

.ailureHaemorrhage

)as controlled

3 4igation of uterine vessel 0

internal iliac arteries3 .ollo)ed by emergency

hysterectomy

.ailure

5 )omen

)omen

% )oman

%6 )omen % )oman

%" )omen 5 )omen

%& )omen


16/40

%esults


Complications 7one of complication

4O2 8 9 : days

;e


17/40

3ollo up


/ )eeks Medical e


18/40

3ertility


8 )omen e % year after

)omen )ere not possible to becomepregnant ;% hysterectomised 0 % tuballigation=

: )omentried to conceive


19/40

3ertility

Manual e


20/40

/iscussion

"ostartum haemorrhage is acommonobstetric emergency

& leading cause of maternalmorbidity $ mortality

$terine atony

as its priary cause



21/40

/iscussion


!sual management 'terinerevision 'terinemassage

-erfusion of uterotonics


22/40

/iscussion


Only fe) hospital

have anintervensional

radiologist

?ngiographic

emboli@ation may bean effective solution


23/40

/iscussion

!terus atony


$ife:threateningbleeding

aemostatic surgeryis ine)itable


24/40


& ne' conser)ati)e surgicalrocedure

Can be erformed inemergency conditioness than 13 minutesasy

*imle 'ithout ris, of)essel 5 ureter in.ury



25/40


Discussion

oen had prior artery ligation

.opression sutures

Good results

.O"P%#-O/ #$$% 5# 5 1# #$%G-.5 #&P#

-/ PO#P5%$" !5&"O%%!5G&


26/40

B&*6C +O8


Bleeding can be controlled bysurgical tamonade of the uterus


27/40

$;9CH 00)


Perfored a surgical techni(ue for

copression 6 apposition beteen

the anterior 6 posterior all of the

uterus in oen ith postpartu

haeorrhage


28/40

CH! et al '(((


#tudy of 2 oen ho underent

haeostatic ultiple s(uare suturingto reduce bleeding 6 a+oid

hysterectoy

An easy & simple technique


29/40

Based on techni(ue described by

.ho et al8 e,cept that they usedsiple trans+erse sutures

3H


30/40

.oplications of infections and

synechiae ha+e been described afterthose copression techni(ues

Compli%ations


nne ! the "men de#elped

cmplicatins

$% ! "men "h su'sequently"ieshed t ha#e anther child had a

term 'irth


31/40


Conclusions

$terine copression suturing is a sipleconser+ati+e procedure designed to stop postpartu

haeorrhage hen the usual anageent fails .an be perfored (uic9ly after caesarean or +aginal

deli+ery

:oes not decrease fertility

7o) the author use uterine compression suturing as the

%ststep in )omen )ith severe postpartum haemorrhage

caused by uterine atony


32/40

.ritical5ppraisal



33/40

.ritical 5ppraisal


Design of study is a case report

(he strengthof this study (his study is one of the largest studies of compression sutures for

postpartum haemorrhage ?ll procedure )ere placed by the same operator

(his study follo) its participants for long time after about complications of theprocedure, byA Medical e


34/40

.ritical 5ppraisal


-s the study +alid

Was there a clearly defined research question? es, there )as Is thene) uterine compression suturing techni*ue effective for reducing

postpartum haemorrhage secondary to severe uterine atony

Was the assignment of patients to treatments randomised? 7o, there

)asnEt ?ll patients )ith postpartum haemorrhage secondary to severe

uterine atony in the hospital )as assigned consecutively

Were all patients accounted for its conclusion? es, there )as 7o dropFoutpatients in this study

2tudy have a long enough follo) up of the patients, that )as

appropriate for outcomes to become manifest

(here )as no intentionFtoFtreat analysis


35/40

.ritical 5ppraisal


Are the #alid results !rm this study( (he uterine compression sutures techni*ue )as sufficient to stop

bleeding immediately in postpartum haemorrhage secondary tosevere uterine atony

)an I apply these #alid* imprtant !indings t mypatient ( es, I Can (he uterine compression sutures is an easy and

simple techni*ue, )hich have not re*uire a lot e


36/40

han9 'ou

Date post:	24-Feb-2018
Category:	Documents
Upload:	drnyol
View:	218 times
Download:	0 times

Uterine Compression Sutures for Postpartum Bleeding With Uterine Atony (WITH FLASH)

Documents