Research Article| Volume 9, ISSUE 2, P101-105, June 1999

Surgical management of severe postpartum haemorrhage

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      In the UK maternal deaths as a result of postpartum haemorrhage (PPH) numbered 1 in 60 000 births in the 1970s, falling to 1 in 200 000 births in the 1990s. However, in developing countries this figure may be as high as 1 in 2000–5000 births. The morbidity is 50 times more common than in developed countries. The improved figures from England and Wales are largely due to prophylactic use of oxytocics in the management of the third stage of labour and is similar to the figures of other developed countries. Confidential enquiries in the developed countries point to avoidable factors. Replacement of blood that is ‘too little and too late’ and ‘delay to initiate and perform definitive surgery’ when there is severe PPH that does not respond to medical management have been highlighted. The role of surgery and various surgical methods in the management of severe PPH is discussed.
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        • Department of Health & Social Security
        Report on confidential enquiries into maternal deaths 1979–1981. Her Majesty's Stationery Office,, London1986
        • Department of Health Welsh Office, Scottish Office Department of Health, Department of Health and Social
        • Services Northern Ireland
        Why mothers die — report on confidential-enquiry into maternal deaths in the United Kingdom.
        The Stationery Office Ltd. The Publications Centre, London1998
        • Kwast B.E.
        • Rochat R.W.
        • Kidane-Mariano W.
        Maternal Mortality in Addis Ababa, Ethiopia.
        Stud Fam Plann. 1986; 17: 288
        • DHSS
        Report on confidential enquiries into maternal deaths 1982–1984. Her Majesty's Stationery Office, London1989
      1. WHO Report of Technical Working Group. The prevention management of postpartum haemorrhage. World Health Organization, Geneva1990 (WHO/MCH/90.7)
        • Gilbert L.
        • Porter W.
        • Brown V.A.
        Postpartum haemorrhage — a continuing problem.
        Br J Obstet Gynaecol. 1987; 94: 67-71
        • Brant H.A.
        Precise estimation of postpartum haemorrhage: difficulties and importance.
        Br Med J. 1967; i: 398-400
        • Newton M.
        • Mosey L.M.
        • Egli G.E.
        • Gifford W.B.
        • Hulls C.T.
        Blood loss during and immediately after delivery.
        Obstet Gynecol. 1961; 17: 9-18
        • Prendiville W.
        • Elbourne D.
        Chalmers I. Enkin M. Keirse M.J.N.C. 3rd edn. Care during the third stage of labour in effective care in pregnancy and childbirth. vol 2. Oxford University Press, Oxford1990: 1145-1169
        • Hesler J.D.
        Postpartum haemorrhage and evaluation of uterine bleeding.
        Obstet Gynaecol. 1975; 45: 501
        • Hayashi R.H.
        The role of prostaglandin in the treatment of postpartum haemorrhage.
        J Obstet Gynaecol. 1990; 10: 521-524
        • Jacobs M.M.
        • Arizas F.
        Intramyometrial prostaglandin F2α in the treatment of severe postpartum haemorrhage.
        Obstet Gynaecol. 1979; 55: 665-666
        • Toppozada M.K.
        Postpartum haemorrhage.
        in: Bygdeman M. Berger G.S. Keith L.G. Prostaglandin and their inhibitors in clinical obstetrics and gynaecology. MTP Press, Lancaster1986: 233-251
      2. 3rd edn. Textbook of obstetrics. Appleton-Century-Crofts, New York1945: 1125-1127
        • Druzin M.L.
        Packing of lower uterine segment for control of post-cesarean bleeding in instances of placenta praevia.
        Surg Gynecol Obstet. 1989; 69: 543-545
        • Maier R.C.
        Control of postpartum haemorrhage with uterine packing.
        Am J Obstet Gynecol. 1993; 169: 317-323
        • Katesmark M.
        • Brown R.
        • Raju K.S.
        Successful use of a Sengstaken - Blakemore tube to control massive post partum haemorrhage.
        Br J Obstet Gynaecol. 1994; 101: 259-260
        • Chan C.
        • Razvi K.
        • Tham F.K.
        • Arulkumaran S.
        The use of Sengstaken - Blakemore tube to control post-partum haemorrhage.
        Int J Obste Gynaecol. 1997; 58: 251-252
        • Burchell R.C.
        Physiology of internal iliac artery ligation.
        J Obstet Gynaecol Br Commn. 1968; 75: 642-651
        • Likeman R.K.
        The boldest possible for checking the bleeding - a new look at an old operation, and a series of 13 cases from an Australian Hospital.
        Aust NZ J Obstet Gynecol. 1992; 32: 256-261
        • Lynch C.B.
        • Coker A.
        • Laval A.H.
        • Abu H.
        • Cowen M.J.
        The BLynch surgical technique for control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported.
        Br J Obstet Gynaecol. 1997; 104: 372-376
        • Clark S.L.
        • Yeh S.Y.
        • Phelan J.
        • Samuel B.
        • Paul R.H.
        Emergency hysterectomy for obstetric haemorrhage.
        Obstet Gynaecol. 1984; 64: 376-380