妇产科学产后出血详解.ppt

* If conservative measures fail to control haemorrhage, initiate surgical haemostasis SOONER RATHER THAN LATER Observational studies report 90.7% success rate Obstet Gynecol Survey 2007; 62(8): 540 Retrospective Cohort -Used in 0.3% deliveries -Failure rate 11% -Factors associated w/ Failure EBL1500ml, 5U PRBCs transfused Obstet Gynecol 2009MAY;113(5):992 Fertility -Gelfoam vs balloon catheters for temporary occlusion -2 case series -34 patients 91% resumed normal menses, 20 pregnancies in 13 women (12 normal delivery at term) Am J Obstet Gynecol 2009APR;200(4):384e1 -28 patients 6pts w/ uncomplicated pregnancy + delivery Obstet Gynecol 2003NOV;102(5 pt 1):904 * If uterine bleeding not responsive to pharmacologic methods no vaginal or cervical lacerations present, surgical exploration may be necessary Goal is to avoid hysterectomy due to high mm as well as possibly preserving fertility. Observational studies report 91.7% success rate for uterine compression sutures. Obstet Gynecol Survey 2007; 62(8): 540 B-Lynch suture shown here in a retrospective cohort was -used in 1 per 1,126 cases of PPH -successful in avoiding hysterectomy 82% of the time -7 of the 23 women had subsequent uncomplicated pregnancy and delivery at term (via ERLTCS) Obstet Gynecol 2007 JUL;110(1):68 -Failure of suture associated with AMA, multiparity, vaginal delivery, delay between delivery and placement of sutures (2-6 hrs vs 1 hr) Obstet Gynecol 2011 JAN; 117(1):14. If haemorrhage secondary to atony, vascular ligation often necessary -O’Leary’s Suture -Case series of 265 patients post C-section delivery with PPH; only 10 required further therapy J Repro Med 1995 MAR; 40(3):189 -No studies on fertility, but good collateral flow, ? extrapolate data from embolization * Multiple Square Sutures -Case series of 23 women, prevented hysterectomy in all 23 -2 months following procedures US confirmed nl uterine cavity and endomtrium -6 of 10 desiring future pregnancies