Methods of uterine hemostasis in PPH

Mahantesh KaroshiLondon, UK

Focussing on the cause..4 “T”s

• Tone – 70%• Tissue – 20%• Trauma- 9%• Thrombin- 1%

PPH Management rules

90% -10 % division

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• High placental blood flow

• Loss of large volume in a short time

• Late detection

• Under-estimation

• Under-filling

Uniqueness of PPH

Principles of management

Simultaneous performance of resuscitation and identifying the specific cause

Uterine blood flow at term

7Fibroids, Menstruation, Childbirth, and Evolution: The Fascinating Story of Uterine Blood Vessels, Fred Burbank

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Tone

Aortic compression

www.glowm.com

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Syntocinon

Ergometrine

Misoprostol

Uterotonics and hemostatics

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Uterine tamponade

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Uterine compression sutures

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Uterine sandwich technique

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The B-Lynch Suture Surgical Technique

Patient positioningSupine position Lloyd- Davies Position

B-Lynch Uterine Compression- Technique

The ten point principle

• Lloyd Davis Position • Exteriorise the uterus• Basic surgical competence required• Perform bimanual compression• Transverse lower segment incision made• Uterine cavity checked, explored &

evacuated.

Compression technique….

• Monocryl No. 1 - 90cm (code:W3709) • Allow free drainage of blood• Check bleeding control vaginally, including swabs and

instruments• Close the abdomen

Causes of failure

• Placenta percreta• Wrong technique • Uncontrolled DIC • No intra- operative test done• Not properly applied• Delayed application

When correctly applied,Even tension; no ischemia; no necrosis;

Hayman Technique

Cho-square suture• University of Seoul (Korea)• 23 cases• Didn’t mention extent of bleeding• Pierce uterus 32 times• Does not close all transverse branches• ? Cavity Patency• Leading to pyometria

What happens if incorrectly applied?

Partial ischemic necrosis of the uterus followinga uterine brace compression suture

• The uterus as it appears at laparotomy, 24 hours following a uterine brace suture.

• An example of poor technique

• No exit point for drainage of the uterine cavity

Novel concepts in the management of PPH-

2014

5 minutes later

To compare……

At the beginning At the end

Before negative pressure applicationAfter negative pressure application

Q & A

Muchas Gracias

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