OB Hemorrhage: Surgical Procedures

Uterine Artery Occlusion

David Lagrew, MD, Andrew Hull, MD

Saddleback Memorial; University of California, San Diego

SUMMARY

As an alternative to conservative measures or hysterectomy for controlling postpartum hemorrhage, many clinicians use temporary balloon occlusion or embolization. The occlusive balloons are placed preoperatively while the patient is stable. Embolization is typically utilized in patients with persistent postpartum postoperative bleeding who are hemodynamically stable enough to tolerate transport to the interventional radiology suite. These procedures are for experienced interventional radiologists given the possible complications and critical state of postpartum hemorrhage patients.

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Uterine Hemostatic Suturing

David Lagrew, MD, Andrew Hull, MD

Saddleback Memorial; University of California, San Diego

SUMMARY

several techniques of uterine compression provide a mechanical method of compressing the uterine musculature and closing the arterial bed leading to reduced bleeding. The main and most frequent indication for these procedures is in the patient with an atonic uterus who is hemodynamically challenged but stable and who desires possible further reproductive capacity. The most common technique is the B-Lynch technique; another technique described by Hayman is similar but simpler. Other techniques of multiple square sutures through the uterine body have been described, but reports of adhesions and abscesses have been published and dampened support.

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