This document outlines the surgical management of postpartum hemorrhage (PPH). It discusses devascularization procedures such as ligating the uterine arteries, ovarian arteries, and internal iliac arteries. It also mentions B-Lynch compression sutures and arterial embolization. Hysterectomy is described as a last resort option if bleeding cannot be controlled through devascularization or other conservative measures. The document provides details on how to perform specific procedures like B-Lynch sutures and ligating various arteries to reduce blood flow to the uterus.

1. SURGICAL
MANAGEMENT OF
PPH
B.Hemanath

2. SURGICAL ANATOMY OF UTERUS

3. It is the final method when all the other methods fail to
control post partum haemorrhage
It includes two steps,
Devascularisation procedure
•a. Ligation of uterine arteries
•b. Ligation of ovarian and ut. artery anastomosis
•c. Ligation of ant. div. of int. iliac artery
•d. B- Lynch compression suture and multiple
square sutures
•e. Angiographic arterial embolisation
Hysterectomy

4. 1. Devascularisation procedure :
A. Ligation of ut. arteries;
Ascending branch of uterine artery ligated b/n
upper and lower uterine segment.
No.1. chromic catgut is used.

5. If bleeding continues.
B. Ligation of ovarian & uterine artery anastamosis:
Done just below the
ovarian ligament. Some times, temporary
occlusion of ovarian vessels at
infundibulopelvic ligament is
done by rubber sleeved clamps.

6. Ligation of uterine artery and utero-ovarian artery

7. C. Ligation of anterior division of internal iliac artery.
Done unilaterally or
bilaterally.
Bilateral ligation avoids
hysterectomy in 50% of
the cases.

8. D. B-Lynch compression sutures &
multiple square sutures
Developed by Christopher B-Lynch.
Used to mechanically compress an atonic uterus in the face of
severe PPH.
Success rate is about 80% and can avoid hysterectomy.

9. B-LYNCH SUTURE

10. E. Angiographic arterial embolisation.
Done to bleeding vessel under
fluoroscopy.
Gel foam is used as embolus.
Success rate >90% & it avoids
hysterectomy.

11. Continuous observation
of patient in ICU/ high
dependency unit.
After this procedure, if
bleeding is controlled,

12. 2.Hysterectomy – Final most step.
Rarely indicated.
Only if uterus fails to
contract & bleeding
continues.
If mother is parous,
decision is taken earlier.
It may be total or subtotal
depending on the case.

13. Examination per
speculum, is
done under good
light.
Identify trauma
to perineum,
vagina, cervix.
Hemostasis
achieved by
appropriate
catgut sutures.
For traumatic PPH