A Study Of Surgical Hemostasis And Its Prognosis During Postpartum Hemorrhage

Objective：To discuss the methods and their clinical significance ofsurgical hemostasis in control postpartum hemorrhage.Methods：108caesarean section patients with postpartum haemorrhagedue to uterine inertia, who failed to respond to conservative management,were performed surgical hemostasis from Jan.2006to Sep.2010at ourhospital.103patients were kept uterine and89cases were followed upsuccessfully. The methods of surgical hemostasis were selected according tothe cause and the part of postpartum hemorrhage. The patients of group Awere treated with “U” suture transfixing anterior and posterior wall of corpusuteri longitudinally (arcuate artery transfixion), and the cases of group B weretreated with longitudinally suturing blood vessels of parametrium due to corpusuteri inertia. The patients of group C were performed “U” suture transfixinganterior (or posterior) uterine wall at lower uterine egment and cervix (e.g.placenta previa). The patients of group D who failed to respond to abovemethods were performed ascending branch of uterine artery ligation. Atrandom,30caesarean section patients without any complication at the sametime were regarded as control group. We analyze the return of menses, thefunction of ovary and uterine blood flow.Results：Hemorrhage were rapid controlled and uterine were kept among89patients. No late postpartum hemorrhage, no serious complication, and nomaternal death happened. There were no statistical difference at lochiaduration, the time of return of menses after delivery, menstrual blood volume ofthe first time after delivery, the times of return normal menstrual blood volumeafter delivery and menstrual cycle among all groups(P＞0.05).The levels ofFSH, LH and E2were no statistical difference at menstrual cycle3to7days at1years later of delivery among all groups (P＞0.05). The RI of bilateral uterineartery and S/D through B-ultrasonography exam were no statistical differenceamong all groups (P＞0.05). The visualization ratio of uterine artery and the mean value of artery diameter through enchanced CT were no statisticaldifference among all groups (P＞0.05).Conclusions：“U” suture transfixing anterior and posterior wall of corpusuteri longitudinally, longitudinally suturing blood vessels of parametrium,“U”suture transfixing anterior (or posterior) uterine wall at lower uterine egmentand cervix, and above methods combined with ascending branch of uterineartery ligation are effective in cases of postpartum haemorrhage due to uterineinertia. These methods are simple, rapid and effective. They can reducebleeding volume and can avoid a subsequent hysterectomy. No seriouscomplication and no maternal death happened. The return of menses, thefunction of ovary and uterine blood flow are normal in89followed-up patients.The surgical hemostasis selected according to the cause and the part ofpostpartum hemorrhage is a safe, effective, and rapid method in controlpostpartum haemorrhage and can be reduce the rate of hysterectomy.