European journal of obstetrics, gynecology, and reproductive biology · 2026
From salvage hysterectomy to damage control: uterine artery ligation with tamponade for AFE with refractory hemorrhage in a 10-year analysis.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Gao Lina, Dong Yan, Lv Ling, Liu Xiaohui, Liu Xiaoling, Liu Jian
Аннотация
BACKGROUND: Amniotic fluid embolism (AFE) is a leading cause of maternal mortality and peripartum hysterectomy. Damage-control surgery offers a theoretical path to uterine preservation, but evidence in AFE is lacking.
OBJECTIVE: To evaluate a paradigm shift from radical hysterectomy to a uterus-preserving damage-control strategy for AFE with refractory postpartum hemorrhage.
METHOD: In this single-center retrospective analysis (2015-2025), patients were categorized into a Radical Surgery Era (2015-2019, n = 5) and a Damage Control Era (2020-2025, n = 6). The latter received a standardized protocol: bilateral uterine artery ligation plus intrauterine tamponade (Bakri balloon or gauze). Descriptive statistics were used.
RESULTS: Among 284,143 deliveries, 11 AFE cases were identified (incidence 3.87/100,000). Maternal survival was comparable (Damage Control 5/6, 83.3% vs. Radical 4/5, 80%). Uterine preservation increased from 0% (0/5) to 66.7% (4/6). Median estimated blood loss was lower (2450 vs. 4000 mL), with no increase in transfusion requirements or ICU stay. Bakri balloon tamponade (2/2) showed more consistent hemostasis and coagulation recovery than gauze packing (2/4).
CONCLUSIONS: A standardized damage-control protocol for AFE-uterine artery ligation with tamponade-is feasible and effective. It preserves maternal survival, significantly increases uterine preservation, and does not increase hemorrhage or resource use. Balloon tamponade appears preferable, supporting fertility preservation in AFE management.
OBJECTIVE: To evaluate a paradigm shift from radical hysterectomy to a uterus-preserving damage-control strategy for AFE with refractory postpartum hemorrhage.
METHOD: In this single-center retrospective analysis (2015-2025), patients were categorized into a Radical Surgery Era (2015-2019, n = 5) and a Damage Control Era (2020-2025, n = 6). The latter received a standardized protocol: bilateral uterine artery ligation plus intrauterine tamponade (Bakri balloon or gauze). Descriptive statistics were used.
RESULTS: Among 284,143 deliveries, 11 AFE cases were identified (incidence 3.87/100,000). Maternal survival was comparable (Damage Control 5/6, 83.3% vs. Radical 4/5, 80%). Uterine preservation increased from 0% (0/5) to 66.7% (4/6). Median estimated blood loss was lower (2450 vs. 4000 mL), with no increase in transfusion requirements or ICU stay. Bakri balloon tamponade (2/2) showed more consistent hemostasis and coagulation recovery than gauze packing (2/4).
CONCLUSIONS: A standardized damage-control protocol for AFE-uterine artery ligation with tamponade-is feasible and effective. It preserves maternal survival, significantly increases uterine preservation, and does not increase hemorrhage or resource use. Balloon tamponade appears preferable, supporting fertility preservation in AFE management.