Surgical methods to control postpartum hemorrhage

1. SURGICAL METHODS TO CONTROL POSTPARTUM
HEMORRHAGE
Sunayana
2k15

2. SURGICAL METHODS:
• Bases on whether she had completed her family or not.
• If the family is completed – hysterectomy ( total or
subtotal) .
• If the family is not completed – uterine devascularization
procedures.

3. UTERINE DEVASCULARIZATION PROCEDURES:
• Mostly these are done in nulliparous women.
• They are:
• B-lynch sutures
• Multiple square sutures
• Ligation of uterine artery
• Ligation of uterine and ovarian anastomoses
• Ligation of internal iliac artery
• Angiographic selective arterial embolization.

4. B-LYNCH SUTURES:
• Alternative to vessel ligation
techniques.
• Vertical brace sutures- appose anterior
and posterior walls of uterus.
• This leads to compression of fundus
and lower uterine segment to control
hemorrhage.

5. MULTIPLE SQUARE SUTURES
• These are aslo called block sutures
• Anterior and posterior walls are approximated untill no space is left
in utreine cavity
. Other sutures used in PPH :
.Hayman sutures
.Cho Sqaure
. Gunnshella suture
Both B-lynch sutures and multiple square sutures avoid hysterectomy
. Success rate is 80%

6. LIGATION TECHNIQUES
• Ligation of uterine artery:
• Ascending branch of uterine artery is
ligated
• Done at the level of internal os
• It is most effective in Atonic PPH
• Suture is passed into myometrium 2cm
medial to artery

7. • Ligation of uterine and ovarian artery anastomoses:
• Done just below ovarian ligament.
• Sometimes temporary occlusion of ovarian artery is done at
infundibulopelvic ligament by rubber sleeved clamps.
• Angiographic selective arterial embolization:
• Done in hemodynamically stable patients.
• Under fluoroscopic guidance femoral artery is catheterised.
• Bleeding vessel is identified and embolization is carried out
using gel foam

8. • Ligation of internal iliac artery:
• Anterior division of internal iliac artery is ligated
• Ligated about 5cms away from common iliac
artery
• Posterior division is not included- as it may lead
to loss of lower limb sensation
• When Bilateral internal iliac artery ligation is
done:
• Pulse pressure reduces by 85%
• Blood flow reduces by 90%

9. HYSTERECTOMY:
• It is most definitive treatment to control pph.
• It is the last resort.
• It is done when uterus fails to contract or all above
measures are failed.
• It may done as total or subtotal hysterectomy.
• In subtotal hysterectomy cervix is not removed.
• Total hysterectomy is done depending on the case.

10. THANK YOU