Uterine Atony: The Most Common Cause of Postpartum Hemorrhage

Background: Postpartum hemorrhage (PPH) remains a significant contributor to maternal morbility and mortality and accounts for 31% of maternal death in Vietnam. The most common cause of PPH is uterine atony. Recently, uterine tamponade using intrauterine condom appears to be an effective tool in the management of intractable PPH. Objectives: To evaluate the success of condom as a tamponade to arrest intractable PPH due to uterine atony in patients not responding to medical management. Materials and Methods: The study was designed as a cross-sectional and descriptive, included 32 patients who underwent condom balloon tamponade at Kontum Provincial Hospital from 1/2012 to 8/2016. Results: 32 women (mean age 25.71 ± 6.45 years range, 16 - 39) underwent condom balloon tamponade for PPH controls. 29 patients (90.62%) successfully responded the tamponade therapy by the use of condom catheter. Three patients (9.37%) required hysterectomy. Conclusions: Condom catheter balloon effectively controls the intractable PPH due to uterine atony. Key words: PPH (Pospartum hemorrhage), Tamponade, Condom catheter balloon, Uterine atony

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Uterine tamponade using condom catheter balloon in the management of non-traumatic postpartum hemorrhage

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182413 ◽

2018 ◽

Vol 7 (7) ◽

pp. 2617

Author(s):

Renu Jain

Keyword(s):

Postpartum Hemorrhage ◽

Therapeutic Option ◽

Ease Of Use ◽

Uterine Atony ◽

Wound Sepsis ◽

Low Resource ◽

Medical College ◽

Obstetrics And Gynaecology ◽

Condom Catheter ◽

Febrile Morbidity

Background: In low-resource countries, Postpartum Hemorrhage (PPH) is the leading cause of maternal mortality. The intrauterine balloon tamponade was recently incorporated into the strategy to manage uterine atony. There are many types of tamponades. Among them, the condom catheter seems to be an efficient and economic intervention for the treatment of PPH in low-resource countries. The aim of present study was to evaluate the effectiveness of the condom catheter balloon in treating postpartum hemorrhage refractory to medical treatment.Methods: The retrospective analysis of 22 cases of PPH, treated with a condom catheter as a conservative therapeutic option, was done in department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India.Results: The condom catheter was successful in controlling PPH in 90.9% cases. It was effective in 94.44% women with uterine atony, who did not respond to uterotonic drugs. It was also effective in one case of placental implantation site bleeding and two cases of deranged coagulation function. In 2 cases it failed to control PPH and peripartum hysterectomy was done. The volume of saline solution used to fill the balloon was from 150 -350 ml and the time for which the balloon remained inflated was 36-48 hours. No case of febrile morbidity and wound sepsis was noted. There was no maternal death.Conclusions: Its ease of use and high effectiveness make condom catheter a useful approach for the conservative management of PPH. This device reduces bleeding, shortens the hospital stay and avoids the need for more aggressive procedures.

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Is uterine artery embolization in postpartum hemorrhage due to uterine atony a fertility-sparing intervention?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.11.948 ◽

2022 ◽

Vol 226 (1) ◽

pp. S572-S573

Author(s):

Rosine Ravaud ◽

Michael Dassa ◽

Jérome Soussan ◽

Jean-Michel Bartoli ◽

Aubert Agostini ◽

...

Keyword(s):

Postpartum Hemorrhage ◽

Uterine Artery Embolization ◽

Uterine Artery ◽

Uterine Atony ◽

Artery Embolization ◽

Fertility Sparing

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Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications

Journal of Nepal Medical Association ◽

10.31729/jnma.2375 ◽

2014 ◽

Vol 52 (193) ◽

pp. 668-676 ◽

Cited By ~ 3

Author(s):

Meena Pradhan ◽

Yong Shao

Keyword(s):

Risk Factors ◽

Caesarean Section ◽

Blood Loss ◽

Postpartum Hemorrhage ◽

Placenta Previa ◽

Uterine Atony ◽

Previous Caesarean Section ◽

Peripartum Hysterectomy ◽

Incidence Risk ◽

Emergency Peripartum Hysterectomy

Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage.Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61) due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333) during the same study period.Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i) blood loss 1000-2000 ml, crude odd ratio (OR) =18.48 (95% CI 5.1-65.7), adjusted odd ratio (AOR) = 9.1 (95% CI 2.2-37.7); (ii) blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4), AOR = 45.3 (95% CI 11.6-176.9); (iii) previous caesarean section, OR = 5.5 (95% CI 2.9-9.7), AOR = 3.7(95% CI 1.4-9.9); (iv) uterine atony, OR = 11.9 (95% CI 5.8-24.6), AOR = 7.5 (95% CI 1.8-30.2); (v) placenta previa, OR = 2.04 (95% CI 1.1-3.5), AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy.Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.

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A Novel Approach to Teaching Placement of a B-Lynch Suture: Description of Technique and Validation of Teaching Model

Journal of Graduate Medical Education ◽

10.4300/jgme-d-11-00186.1 ◽

2012 ◽

Vol 4 (3) ◽

pp. 367-369 ◽

Cited By ~ 1

Author(s):

Patrick F. Vetere ◽

Christopher P. Wayock ◽

Jolene Muscat ◽

Genevieve Sicuranza

Keyword(s):

Postpartum Hemorrhage ◽

Pilot Project ◽

Training Model ◽

Realistic Model ◽

Uterine Atony ◽

Gravid Uterus ◽

Rank Test ◽

Large Hospital ◽

Convenience Sample ◽

Fertility Sparing

Abstract Introduction Postpartum hemorrhage is a major cause of maternal morbidity and mortality throughout the world and uterine atony is the leading cause of postpartum hemorrhage. The B-Lynch brace suture is a fertility-sparing approach to treating intractable uterine atony at the time of cesarean delivery. However, many obstetricians lack confidence to perform this procedure, which they may not have performed during residency. In order to train all residents to perform the B-Lynch brace suture, we developed a realistic model by using a flank steak to imitate a gravid uterus. Methods A convenience sample of obstetrics-gynecology faculty and residents at different levels of training at a single large hospital participated in this pilot project. Each physician reported self-perceived understanding of and confidence in performing the B-Lynch procedure before and immediately after practicing the technique using the flank-steak model, via a Likert-type survey (scale 1 = low, 5 = high). A Wilcoxon matched-pairs signed rank test was used to compare the before and after responses. Results Thirty-four participants completed the flank-steak model training and pretraining/posttraining surveys. The median score (range) for self-perceived understanding was 4 (2–5) and increased to 5 (4–5) (P < .01) after exposure to the training model. The confidence scores rose from 3 (1–5) to 5 (4–5) (P < .01) after training. Conclusion The flank-steak model for teaching the B-Lynch suture significantly improved resident and faculty self-perceived understanding of and confidence in performing this procedure, which is otherwise rarely practiced in residency.

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Carbetocin In Prevention of Uterine Atony Following Delivery by Cesarean Section in Population Who Experienced Postpartum Hemorrhage: Costs in Polish Settings

Value in Health ◽

10.1016/j.jval.2016.03.1435 ◽

2016 ◽

Vol 19 (3) ◽

pp. A176 ◽

Cited By ~ 1

Author(s):

K Pacocha ◽

I Pieniazek ◽

M Sobkowski ◽

Z Celewicz ◽

J Kalinka ◽

...

Keyword(s):

Cesarean Section ◽

Postpartum Hemorrhage ◽

Uterine Atony

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Severe Postpartum Hemorrhage from Uterine Atony: A Multicentric Study

Journal of Pregnancy ◽

10.1155/2013/525914 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 15

Author(s):

Carlos Montufar-Rueda ◽

Laritza Rodriguez ◽

José Douglas Jarquin ◽

Alejandra Barboza ◽

Maura Carolina Bustillo ◽

...

Keyword(s):

Postpartum Hemorrhage ◽

Target Organ Damage ◽

Hypovolemic Shock ◽

Uterine Atony ◽

Teaching Hospitals ◽

Transfusion Therapy ◽

Maternal Deaths ◽

Multicentric Study ◽

Live Births ◽

Prospective Longitudinal

Objective. Postpartum hemorrhage (PPH) is an important cause of maternal mortality (MM) around the world. Seventy percent of the PPH corresponds to uterine atony. The objective of our study was to evaluate multicenter PPH cases during a 10-month period, and evaluate severe postpartum hemorrhage management.Study Design. The study population is a cohort of vaginal delivery and cesarean section patients with severe postpartum hemorrhage secondary to uterine atony. The study was designed as a descriptive, prospective, longitudinal, and multicenter study, during 10 months in 13 teaching hospitals.Results. Total live births during the study period were 124,019 with 218 patients (0.17%) with severe postpartum hemorrhage (SPHH). Total maternal deaths were 8, for mortality rate of 3.6% and a MM rate of 6.45/100,000 live births (LB). Maternal deaths were associated with inadequate transfusion therapy.Conclusions. In all patients with severe hemorrhage and subsequent hypovolemic shock, the most important therapy is intravascular volume resuscitation, to reduce the possibility of target organ damage and death. Similarly, the current proposals of transfusion therapy in severe or massive hemorrhage point to early transfusion of blood products and use of fresh frozen plasma, in addition to packed red blood cells, to prevent maternal deaths.

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