Conservative surgical techniques for treatment of massive obstetric hemorrhage in abnormal placental ipmlantation and uterine atony

Objectives 

The aim of this study was to discuss the use of new conservative surgical techniques in cases of postpartum massive hemorrhage in abnormal placentation and uterine atony, and to discuss our experience and thereby contribute to the literature.

Yöntem

We prospectively designed this study to include 24 patients and collected the data during the 21-month period between April 2013 and January 2015. The patients’ characteristics, antepartum diagnosis methods, gestational age and fetal weight, as well as the surgical techniques used, technical details, blood transfusion, maternal morbidity, complications, and mean duration of hospitalization were assessed.

Results 

The new conservative surgical techniques were used in 24 patients during the 21-month period. Placenta accreta was diagnosed in 22 patients who had previous cesarean sections. The mean maternal age was 34.54±4.28 (23 to 43) years, the mean gestational age was 36.68±1.80 (30+ to 38+) weeks, and the mean infant weight was 2,787.82±640.12 (800 to 3.695) grams, with the exception of two fetuses that were terminated in early gestation. All patients were operated on using Pfannenstiel and lower uterine segment transverse incision. Yalinkaya’s techniques were used to treat all patients for hemostasis. Compression sutures and balloons were required for 12 patients. Uterine atony occurred in three patients. A surgical complication (bladder injury) occurred in only one case. A total six patients required blood transfusions; 2 units of blood were each given to four patients, and 3 units were each given to two patients. The average preoperative and postoperative hemoglobin (Hb) and hematocrit (Htc) levels were calculated as 11.21±1.63 g/dl and 9.68±1.13 g/dl and as 34.81±4.35% and 29.82±3.39%, respectively. The mean duration of hospitalization was 1.79±1.38 days. Serious maternal complications or maternal mortality did not occur.

Sonuç

We suggest that Yalinkaya’s techniques are the most effective for massive postpartum hemorrhage. Therefore, if obstetric surgeons and their teams perform these techniques, the number of serious maternal complications and rates of mortality can be decreased. However, these medical professionals will need to improve their experiences and abilities in order to perform these techniques successfully­

Anahtar Kelimeler