A fatal case of hypovolemic shock after cesarean section.
ABSTRACT We report a fatal case of hypovolemic shock caused by uncontrollable hemorrhaging after emergency cesarean section. In this patient, the incision in the uterus was located only 1 cm from the cervical os. We suspect that this close incision was the cause of the damage to the uterine venous plexus and the bleeding. We discuss the cause of death and offer advice on performing autopsies in patients who have died of bleeding after cesarean section.
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ABSTRACT: Analysis of indications and post-operative course in patients after obstetric hysterectomy. 45 cases of obstetric hysterectomy were analysed. Mean age of operated woman was 32.18 +/- 4.31 years. Mean gestational age was 35.9 +/- 1.76 weeks. The estimated rate of obstetric hysterectomy was 2.5 per 1000 deliveries. The most frequent indication for urgent hysterectomy were placentation disorders. Elective hysterectomy was performed because o invasive cervical cancer and uterine myomas. Mean time of duration of surgery was 91.67 min. 1. Indications for obstetric hysterectomy should be stated very carefully and the operation should be performed by the most experienced staff. 2. In case of severe intraoperative bleeding internal iliac artery ligation should be performed.Ginekologia polska 08/2004; 75(7):514-7. · 0.68 Impact Factor
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ABSTRACT: Update of knowledge on the various methods of management of intractable postpartum haemorrhage. PubMed, MEDLINE were the electronic sources, in English and French languages, used for data retrieval. Uterine atony and abnormal placental insertions (placenta praevia or accreta) are the major causes of primary postpartum haemorrhages. To preserve fertility, we dispose of angiographic selective embolization or surgical vascular ligations. Embolization is a non-invasive method practicable by simple catheterization under local anesthesia. Vascular ligations of the uterine vessels or internal iliac arteries require mostly laparotomy. New and easier surgical methods, such as uterine compression or hemostatic suturing techniques have been described for which we lack experience. For uterine atony, the success rate of arterial embolization and uterine artery ligations is close to 100%. Ligation of internal iliac arteries is a little less effective and technically more difficult to carry out. It remains interesting in obstetrical traumatic hurts, which do not concern the uterus. If bleeding from the lower segment occurs during caesarean section, low uterine artery ligatures are necessary. These methods are all the more effective than they are prematurely implemented before the rise of major coagulopathy. In this case, uterine devascularization has also to be applied to ovarian vessels. With placenta accreta, accreta portion of the placenta can be left in place and arterial embolization or vascular ligations can be done. Nevertheless the main cause of failure with conservative treatments is placenta accreta. The simplest and the least morbid methods must be retained. After vaginal birth, arterial embolization can be done, if there is no maternal haemodynamic disorder nor interventional vascular radiology unit nearby. During caesarean section, progressive uterine artery ligation can be done adapted to the bleeding cause. In case of failure of a conservative treatment, it would be dangerous to multiply techniques. Emergency peripartum then should remain the choice procedure.Gynécologie Obstétrique & Fertilité 05/2004; 32(4):320-9. · 0.58 Impact Factor
Article: Management of obstetric hemorrhage.[Show abstract] [Hide abstract]
ABSTRACT: A reluctance to proceed with hysterectomy for obstetric hemorrhage may be a more likely cause of preventable death in obstetrics than a lack of surgical or medical skills. Every obstetric unit should have protocols available to deal with hemorrhage and, in addition, have specific guidelines for patients who object to blood transfusions for various reasons. Risk factors for hemorrhage should be identified antenatally, using all possible imaging modalities available, and utilizing multidisciplinary resources whenever possible. Novel strategies for prenatal diagnosis of abnormal placentation include advanced sonography and magnetic resonance imaging. Placement and utilization of arterial catheters for uterine artery embolization is becoming more widespread and new surgical technology such as the argon beam coagulator seems promising. When intra or postpartum hemorrhage is encountered, a familiar protocol for dealing with blood loss should be triggered. Timely hysterectomy should be performed for signs of refractory bleeding. Application of medical and surgical principles combined with recent technologic advances will help the obstetrician avoid disastrous outcomes for both mother and fetus.Seminars in Perinatology 03/2003; 27(1):86-104. · 2.42 Impact Factor