Efficacy of surgical techniques to control obstetric hemorrhage: analysis of 539 cases.

OBJECTIVE

To analyze the efficacy of surgical techniques to stop excessive obstetric bleeding.

DESIGN

Retrospective follow up.

SETTING

Center for Medical Education and Clinical Research and a total of twelve hospitals in Buenos Aires.

POPULATION: Five hundred and thirty-nine consecutive patients were included: 361 had placenta accreta-percreta, 114 uterine atony, 19 cervical scar pregnancy, 21 placenta previa and 24 uterine-cervical-vaginal tears. Three hundred and forty-seven women had surgery, of whom 192 were emergencies.

METHODS

The surgical techniques included selective arterial ligation and compression procedures. The effectiveness of the techniques was assessed by cessation of bleeding according to source. Follow up included hysteroscopy of 100 patients and magnetic resonance imaging of 341 patients.

MAIN OUTCOME MEASURES: Strong association between topographical uterine irrigation areas and surgical hemostatic technique was established.

RESULTS

Hemorrhage stopped following arterial ligation or compression sutures in 499 women, but hysterectomy was needed in 40. In cervical, lower segment and upper vaginal bleeding, Cho's compression sutures proved to be an efficient and simple procedure. Most surgical hemostatic failures that led to hysterectomy occurred in women with severe hemodynamic deterioration and coagulopathy. Two women died due to multiorgan failure. After surgery, 116 successful pregnancies were reported.

CONCLUSIONS

Bilateral occlusions of the uterine artery or its branches were useful procedures to stop upper uterine bleeding. Square sutures were a simple and effective procedure to control lower genital tract bleeding.