Study of the Role of Conservative Surgical Methods During Cesarean Section to Reduce Postpartum Hemorrhage

Document Type : Original Article

Authors

1 Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.

2 MBCCH, Faculty of Medicine –Al Azhar Al Sharif University

3 Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt

4 Department, Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt

Abstract

Background: Conservative surgical methods in the management of postpartum hemorrhage (PPH) cover operations that preserve fertility and prevent the need for a hysterectomy, they provide simplicity, safety and efficacy. Efficacy is defined as the ability to stop the bleeding after the hemostatic technique has been performed. This study aimed to assess the effectiveness of conservative surgical methods in the reduction of blood loss and management of PPH to avoid hysterectomy.

Methods: Stepwise uterine devascularization and uterine compressive sutures were performed for 78 patients in this interventional cohort study to control intractable PPH not responding to classic management. This study entailed four procedures: compressive sutures, bilateral uterine artery ligation, bilateral utero-ovarian artery ligation and internal iliac artery ligation. All patients were divided into four groups, and we did one single procedure in each group, so if bleeding was not controlled by one procedure a second procedure was done then third and fourth procedure until bleeding stopped.

Results:

We found that the success rate of uterine compression suture +ovarian artery ligation Uterine artery ligation was 25.9%. Finally, the success rate of the combined four methods of conservative surgical management was 75%, the most prevalent intraoperative and postoperative complications are bladder injury and admission to the intensive care unit (ICU) (7.8 and 14 % of cases respectively).

Conclusion:

To achieve a high success rate of conservative surgical management for early PPH, we recommend that obstetricians decide to perform early conservative surgical procedures

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Zagazig University Medical Journal

Articles in Press, Accepted Manuscript
Available Online from 26 September 2023

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