TITLE:
A New Surgical Way to Face Postpartum Hemorrhage
AUTHORS:
Loutfi Guennoun Abdelmounaim, N. Biougnach, Barka Rabea, Harbil Driss, Tmiri Adil, Lafkir Said
KEYWORDS:
Postpartum: PPH, Hemorrhage, Surgical, Technique, Uterus, Plication, Vascular, Ligation, Hemostatic, Hematometry, Amenorrhea and Isthmocoele
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.9,
September
3,
2020
ABSTRACT: Objective: We introduced
two novel hemostatic techniques to achieve hemostasis for postpartum hemorrhage
(PPH). The first one (A: Uterus Isthmic Plication) was a new uterine compression
suture, which compresses the hysterotomy site. In a severe case, we further added
vessel ligation suture after performing A-suture
(B-combination suture: B-suture: A + Wide Lateral Uterine Vascular Ligation). Methods: Of 130 PPH cases, 90 were with mild PPH and 40 were with severe
PPH. Our policy was: perform A-suture to mild PPH and perform B (combination) to
severe PPH. Study was performed during 2018-2019. The primary endpoint to evaluate
the efficacy of the procedures was preserving
the uterus (no hysterectomy). Results: A-procedure, performed to 90
patients with mild PPH, was effective to all 90 patients, with all preserving the
uterus. B-procedure, performed 38 patients with severe PPH (excluding two patients
with uterine rupture), was effective in 37 patients, with one having undergone hysterectomy
due to coagulopathy. Conclusion: Uterus Isthmic Plication (A-procedure) and
addition of Wide Lateral Uterine Vascular Ligation to procedure-A (B-procedure)
achieved hemostasis in patients with PPH. Prospective study is necessary to confirm
the present data.