Management of caesarean section postpartum hemorrhage

A.D. Stănescu, R.M. Sima, D. Bălălău, L. Pleș

Rezumat: Introduction. Postpartum haemorrhage is an important cause of maternal mortality and morbidity. The most common causes are: uterine atonia, lacerations, abnormal placental adhesions and coagulopathy. Materials and method. We have reviewed international medical databases with randomized studies, meta-analyzes of current trends in postpartum hysterectomy and alternative techniques in postpartum hemorrhage. Results. The incidence of postpartum hemorrhage is 1% under a rapid therapeutic attitude. The treatment is directed to the cause. Thus, for initial uterine atony, pharmacological means and subsequent surgical gestures such as ligature of the uterine artery - O’Leary or ligature of the hypogastric artery are initiated. Sutura B-Lynch and its variants are designed to perform the compression of the uterus by mechanical force. Uterine balloons are designed to perform placental bleeding areas buffering. This is the most effective method because the catheter applies direct blood pressure to the bleeding site. Uterine bladder devices specifically designed for uterine tamponade after vaginal or caesarean birth include: Foley catheter, Bakri baloon, B-T Cath device and double-bladder device Ebb, which is also designed for cervical haemostasis. Interventional radiology requires advanced, minimally invasive management of postpartum hemorrhage. Conclusions. The use of uterotonics, pelvic vascular ligatures and balloon buffers are the first steps in the therapeutic approach to postpartum hemorrhage. Appropriate conduct consists of a proactive attitude, often with a multidisciplinary team.
Cuvinte cheie: Bakri balloon, B-Lynch suture, O’Leary ligature.