Basic principles of understanding uterine aemostasis, physiology, pathology and management discussed

1. Methods of uterine
hemostasis in PPH
Mahantesh Karoshi
London, UK

3. Focussing on the cause..
4 “T”s
• Tone – 70%
• Tissue – 20%
• Trauma- 9%
• Thrombin- 1%

4. PPH Management rules
90% -10 % division
4

5. • High placental blood flow
• Loss of large volume in a short time
• Late detection
• Under-estimation
• Under-filling
Uniqueness of PPH

6. Principles of
management
Simultaneous
performance of
resuscitation and
identifying the specific
cause

7. Uterine blood flow at term
7
Fibroids, Menstruation, Childbirth, and Evolution: The Fascinating Story of Uterine Blood Vessels, Fred Burbank

8. 8

9. 9

10. Tone

11. Aortic compression
www.glowm.c
om

12. 12
Syntocinon
Ergometrine
Misoprostol

13. Uterotonics and
hemostatics
13

15. Uterine tamponade
15

16. Uterine compression sutures
16

17. Uterine sandwich technique
17

18. The B-Lynch Suture
Surgical Technique

19. Patient positioning
Supine position Lloyd- Davies Position

20. B-Lynch Uterine Compression-
Technique
The ten point principle
• Lloyd Davis Position
• Exteriorise the uterus
• Basic surgical competence required
• Perform bimanual compression
• Transverse lower segment incision made
• Uterine cavity checked, explored &
evacuated.

21. Compression technique….
• Monocryl No. 1 - 90cm (code:W3709)
• Allow free drainage of blood
• Check bleeding control vaginally, including swabs and
instruments
• Close the abdomen

22. Causes of failure
• Placenta percreta
• Wrong technique
• Uncontrolled DIC
• No intra- operative test done
• Not properly applied
• Delayed application

23. When correctly applied,
Even tension; no ischemia; no necrosis;

24. Hayman Technique

25. Cho-square suture
• University of Seoul
(Korea)
• 23 cases
• Didn’t mention
extent of bleeding
• Pierce uterus 32 times
• Does not close all
transverse branches
• ? Cavity Patency
• Leading to pyometria

26. What happens if incorrectly
applied?

27. Partial ischemic necrosis of the uterus following
a uterine brace compression suture
• The uterus as it
appears at
laparotomy, 24 hours
following a uterine
brace suture.
• An example of poor
technique
• No exit point for
drainage of the
uterine cavity

28. Novel concepts in the
management of PPH- 2014

31. 5 minutes later

33. To compare……

34. At the beginning At the end

35. Before negative pressure application
After negative pressure application

36. Q & A

37. Muchas Gracias

38. 38