7. Các PP ngoại khoa trong điều
trị BHSS.
1. Uterine packing.
2. Thắt ĐM tử cung.
3. Thắt ĐM chậu trong.
4. May mũi B-Lynch (Christopher
Balogun Lynch).
5. Cắt tử cung.
6. Thuyên tắc ĐM tử cung sau sanh.
8. Thắt mạch máu của tử cung.
Báo cáo lần đầu tiên ở Ai Cập.
Hiệu quả kiểm soát được BHSS 80%.
Thắt ĐM tử cung 1 bên.
Thắt ĐM tử cung 2 bên ở phần trên của đoạn dưới TC.
Thắt ĐM cổ TC.
Thắt ĐM buồng trứng 1 bên và 2 bên.
15. J Reprod Med. 1995 Mar;40(3):189-93.
Uterine artery ligation in the control of postcesarean
hemorrhage.
O'Leary JA.
• Source
Department of Obstetrics and Gynecology, Easton
Hospital, Pennsylvania, USA.
• Abstract
The technique is described for devascularizing the post-
cesarean section uterus with bilateral mass ligation of the
ascending branches of the uterine arteries and veins. This
30-year clinical experience with 265 patients includes the
results and complications. Ten patients required additional
therapy. The effectiveness of this technique makes it a
reasonable alternative to hypogastric artery ligation and
reduces the need for hysterectomy.
16. Thắt ĐM chậu trong
CĐ:
Mất trương lực cơ TC trong nhau bong
non.
Thai trong ổ bụng làm tổ vùng chậu có
cài răng lược.
Trước hoặc sau cắt TC do BHSS.
Chảy máu trong đáy dây chằng rộng,
chảy máu vách chậu, góc âm đạo.
Vỡ TC lộ ĐM TC gần nguyên ủy ĐM
chậu trong.
Rách rộng.
17. • Chảy máu không cầm được trong phẫu thuật sản khoa và vùng chậu.
• Có thể cứu mạng, bảo tồn TC.
• Có thai lại cũng được báo cáo.
• Chảy máu TC giảm do sau thắt ĐM không có áp lực và mạch đập.
Giống như 1 tĩnh mạch.
• Nắm giải phẫu, có kỹ năng và kinh nghiệm.
• Nguy cơ tổn thương niệu quản và các cấu trúc khác.
• Trong thai kỳ khó thực hiện hơn và thành công ít hơn (<50%).
(Papp z. Int J Gynaecol Obstet 2006 Jan)
21. J Gynecol Obstet Biol Reprod (Paris). 2002 Nov;31(7):629-39.
[Vascular ligation for severe obstetrical hemorrhage: review of the literature].
[Article in French]
Salvat J, Schmidt MH, Guilbert M, Martino A.
Source
Service de Gynécologie, Oncologie et Mammaire, Hôpitau de Léman, site G Pianta, 74203
Thonon.
Abstract
OBJECTIVE:
Assess the contribution of vascular ligation in the treatment of severe obstetrical hemorrhage.
Method. We reviewed the anatomic and pathophysiological basis of vascular ligation analyzing
the technique, results, and indications for this conservative procedure for the severe post-
partum hemorrhage. New developments in suture techniques for uterine bleeding are under
study.
RESULTS:
Outcome after uterine artery ligation is good. A stepwise procedure with progressive ligation of
the uterine and ovarian arteries is a good solution (100% success). Bilateral ligation of the
hypogastrics can provide success in 66% of cases. Vascular ligation can be an alternative
between embolization and hysterectomy.
CONCLUSION:
Ligation of the bleeding vessels preserves the patient's life and uterus. More than fifty
pregnancies have been reported after vascular ligation.
22. Thuyên tắc ĐM TC
Highly feasible, safe & beneficial procedure,
possibly precluding further laparotomy &
hysterectomy
If successful, not only saves the patient’s life, but
also preserves the functions of uterus ,tubes and
ovaries.
Should be the procedure of choice for PPH prior to
surgical intervention
23. Ưu điểm:
• Bảo tồn khả năng sinh sản.
• Hữu dụng trong xuất huyết do nhau tiền đạo.
Khuyết điểm:
• Yêu cầu KTV xạ hình có kinh nghiệm, trong vòng
24 giờ.
• BN ổn định.
• Biến chứng: hoại tử thành TC, ảnh hưởng của
thuốc cản quang, hematoma khu trú.
29. Gynecol Obstet Fertil. 2004 Apr;32(4):320-9.
[Intractable postpartum haemorrhages: where is the place of vascular ligations, emergency peripartum hysterectomy or arterial
embolization?].
Sergent F, Resch B, Verspyck E, Rachet B, Clavier E, Marpeau L.
• Source
Clinique gynécologique et obstétricale, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France. fabrice.sergent@chu-
rouen.fr
• Abstract
• OBJECTIVE:
Update of knowledge on the various methods of management of intractable postpartum haemorrhage.
• METHOD:
PubMed, MEDLINE were the electronic sources, in English and French languages, used for data retrieval. Uterine atony and abnormal
placental insertions (placenta praevia or accreta) are the major causes of primary postpartum haemorrhages. To preserve fertility, we
dispose of angiographic selective embolization or surgical vascular ligations. Embolization is a non-invasive method practicable by
simple catheterization under local anesthesia. Vascular ligations of the uterine vessels or internal iliac arteries require mostly
laparotomy. New and easier surgical methods, such as uterine compression or hemostatic suturing techniques have been described for
which we lack experience.
• RESULTS:
For uterine atony, the success rate of arterial embolization and uterine artery ligations is close to 100%. Ligation of internal iliac arteries
is a little less effective and technically more difficult to carry out. It remains interesting in obstetrical traumatic hurts, which do not
concern the uterus. If bleeding from the lower segment occurs during caesarean section, low uterine artery ligatures are necessary.
These methods are all the more effective than they are prematurely implemented before the rise of major coagulopathy. In this case,
uterine devascularization has also to be applied to ovarian vessels. With placenta accreta, accreta portion of the placenta can be left in
place and arterial embolization or vascular ligations can be done. Nevertheless the main cause of failure with conservative treatments is
placenta accreta.
• CONCLUSION:
The simplest and the least morbid methods must be retained. After vaginal birth, arterial embolization can be done, if there is no
maternal haemodynamic disorder nor interventional vascular radiology unit nearby. During caesarean section, progressive uterine artery
ligation can be done adapted to the bleeding cause. In case of failure of a conservative treatment, it would be dangerous to multiply
techniques. Emergency peripartum then should remain the choice procedure.
41. Cho Multiple Square
Compression Sutures
Multiple square sutures
are used to cover the
whole body of uterus using
a straight 10-cm needle
May be useful in placenta
previa
42.
43.
44. Int J Gynaecol Obstet. 2005 Jun;89(3):236-41. Epub 2005 Apr 19.
The B-Lynch and other uterine compression suture techniques.
Allam MS, B-Lynch C.
• Source
Department of Obstetrics and Gynaecology, South Glasgow University Hospitals,
Glasgow, UK. allamgoweini@hotmail.com
Abstract
• BACKGROUND:
Postpartum hemorrhage (PPH) remains among the 5 main causes of maternal death in
developing and developed countries, and uterine atony is the most common cause (75-
90%) of primary PPH. Uterine compression sutures running through the full thickness
of both uterine walls (posterior as well as anterior) have recently been described for
surgical management of atonic PPH. Christopher B-Lynch was the first to highlight this
revolutionary principle, and other uterine compression suture techniques have since
been described by Hayman and Cho.
• OBJECTIVES:
Step-by-step description of the B-Lynch brace suture and discussion of the current
compression suture techniques.
• CONCLUSIONS:
The different uterine suture techniques have proved to be valuable and safe alternatives
to hysterectomy in the control of massive PPH, and the present review can make the
surgeon better aware of their effective use and the risks they may entail.
45. Success rates of the new Technological
measures in the management of PPH
Method Number of
Cases
Success
Rates (%)
95% CI
(%)
B-Lynch/compression
sutures
108 91.7 84.9–95.5
Arterial embolization 193 90.7 85.7–94.0
Arterial ligation/pelvic
devascularization
501 84.6 81.2–87.5
Uterine balloon tamponade 162 84.0 77.5–88.8
There was no statistically significant difference between the four groups (P = 0.06).
