Obstetrical hemorrhage comprises: 1) bleeding after 24 weeks of pregnancy and before delivery (antepartum hemorrhage) generally
related to placenta previa, placental abruption, trauma and uterine rupture,
and 2) postpartum hemorrhage (PPH)
related to is associated to uterine atony, retained products of conception, genital trauma,
inverted uterus, and secondary hemorrhages (i.e pre-eclampsia, intrauterine sepsis, retained dead fetus,
primary coagulopathy, etc).
Uterine atony after delivery accounts for 75-90% of all PPHs.
This rate may vary depending on the studied region of the world.
Severe PPH hemorrhages are frequently associated with disseminated intravascular coagulopathy (DIC) and high mortality risk.
Various approaches have been proposed for the management of PPH due to atony yet a significant number of cases end in hysterectomy,
procedure not exempt of risks and or complications. Women who survive a PPH are bound to have severe anemia and infections and are
more prone to die in the year following PPH episode.
The International Federation of Gynecology and Obstetrics (FIGO) and other international organizations have given different
recommendations to prevent and treat PPH. A very successful session during the South African
FIGO congress was that devoted to the management of PPH.
The B-Lynch technique comprises a compressive suture of the uterine fundus placed after hysterotomy and fetal extraction
[B-Lynch et al 1997, Ferguson et al 2000, Hayman et al 2002]. The brace suture is easy to be applied
and provides the possibility of preserving female fertility.
Moreover the procedure is easier to perform than hysterectomy or
a hypogastric artery ligature, most convenient for developing
countries with low resources and high obstetrical output.
Post partum hemorrhage.
Summary (1min, 39 sec).
Pathfinder International: Prevention and Management of Postpartum Hemorrhage.
This clinical training video provides
detailed guidance on the active management of the third stage of labor.
How to do the B-Lynch suture (GHS), 2.36 min.
B-Lych suture, 1,51 min.
Bakri Postpartum Balloon: Procedural steps and animation.
Mousa HA, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2003; :CD003249.
Lu MC, Fridman M, Korst LM, et al. Variations in the incidence of postpartum hemorrhage across hospitals in California. Matern Child Health J 2005; 9:297.
Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994-2006. Am J Obstet Gynecol 2010; 202:353.e1.
Prata N, Gerdts C. Measurement of postpartum blood loss. BMJ 2010; 340:c555.
Andolina, K, Daly, S, Roberts, N, et al. Objective measurement of blood loss at delivery: is it more than a guess? Am J Obstet Gynecol 1999; 180:S69.
Dildy GA 3rd. Postpartum hemorrhage: new management options. Clin Obstet Gynecol 2002; 45:330.
Sheiner E, Sarid L, Levy A, et al. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J Matern Fetal Neonatal Med 2005; 18:149.
Rouse DJ, Leindecker S, Landon M, et al. The MFMU Cesarean Registry: uterine atony after primary cesarean delivery. Am J Obstet Gynecol 2005; 193:1056.
Cheng YW, Delaney SS, Hopkins LM, Caughey AB. The association between the length of first stage of labor, mode of delivery, and perinatal outcomes in women undergoing induction of labor. Am J Obstet Gynecol 2009; 201:477.e1.
Nichols WL, Hultin MB, James AH, et al. von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA). Haemophilia 2008; 14:171.
Novello, A, King, JC. Health Advisory: Prevention of Maternal Deaths Through Improved Managementof Hemorrhage. www.acog.org/acog_districts/dist_notice.cfm?recno=1&bulletin=1517. (Accessed May 2, 2006).
Turan J, Ojengbede O, Fathalla M, et al. Positive effects of the non-pneumatic anti-shock garment on delays in accessing care for postpartum and postabortion hemorrhage in Egypt and Nigeria. J Womens Health (Larchmt) 2011; 20:91.
Miller S, Martin HB, Morris JL. Anti-shock garment in postpartum haemorrhage.
Best Pract Res Clin Obstet Gynaecol 2008; 22:1057.
Alexander J, Thomas P, Sanghera J. Treatments for secondary postpartum haemorrhage. Cochrane Database Syst Rev
Hoveyda F, MacKenzie IZ. Secondary postpartum haemorrhage: incidence, morbidity and current management.
BJOG 2001; 108:927.
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