Korean J Obstet Gynecol.  2010 Apr;53(4):313-323. 10.5468/kjog.2010.53.4.313.

A clinical analysis of 10 cases of relaparotomy after emergency postpartum hysterectomy

Affiliations
  • 1Department of Obstetrics and Gynecology, Hallym University College of Medicine, Chunchon, Korea. ycho@hallym.or.kr

Abstract


OBJECTIVE
To analysis the 10 cases of relaparotomy for intractable hemorrhage after emergency postpartum hysterectomy with massive transfusion.
METHODS
Between January 1995 and December 2008, relaparotomies for intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy with massive transfusion were performed on 10 patients. Medical records were reviewed and detailed to collect clinical data including patients' clinical status, causes of bleeding, duration from hysterectomy to relaparotomy, bleeding sites, procedures for bleeding control, amount of transfusions, complications and prognosis.
RESULTS
In relaparotomies, the points of bleeding were identified in all cases and multiple bleeding foci than one bleeding focus were found, and procedures for bleeding control were performed. In 8 cases, the bleeding were controlled successfully and these patients recovered without long term sequales. But in the other 2 cases, although the bleeding controls were successful during relaparotomy and bleeding amount decreased after relaparotomy, but bleeding amount increased the next day and angiographic embolizations were performed. These patients died due to multi-organ failure and continued bleeding. In one of these cases, the endotracheal intubation had been done on arrival at our hospital with postpartum hemorrhage after vaginal delivery at private clinic. In another case, the cardiopulmonary resuscitation was performed on arriving at our hospital with intractable bleeding after postpartum subtotal hysterectomy in other hospital.
CONCLUSION
In most cases, bleeding controls for intractable bleeding after postpartum hysterectomy were successful during and after relaparotomy in spite of development of dilutional coagulopthy due to massive transfusion, and resulted in rapid recovery and good prognosis. Even though dilutional coagulopthy was developed because of massive transfusion, relaparotomy was safe and effective procedure for management of intractable hemorrhage after emergency postpartum hysterectomy with clotting factor replacement. If personnel and adequate clotting factor replacement are available, relaparotomy should not be delayed for management of intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy.

Keyword

Postpartum hysterectomy; Dilutional coagulopathy; Relaparotomy; Postpartum hemorrhage; Massive transfusion

MeSH Terms

Cardiopulmonary Resuscitation
Emergencies
Hemorrhage
Humans
Hysterectomy
Intubation, Intratracheal
Medical Records
Postpartum Hemorrhage
Postpartum Period
Prognosis
Vital Signs

Reference

1. World Health Organization. Revised 1990 estimates of maternal mortality: a new approach by WHO and UNICEF. 1996. Geneva: World Health Organization.
2. Berg CJ, Chang J, Callaghan WM, Whitehead SJ. Pregnancy-related mortality in the United States, 1991-1997. Obstet Gynecol. 2003. 101:289–296.
Article
3. New estimates of maternal mortality. Wkly Epidemiol Rec. 1996. 71:97–100.
5. American College of Obstetricians and Gynecologists. ACOG educational bulletin. Postpartum hemorrhage. Number 243, January 1998 (replaces No. 143, July 1990). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1998. 61:79–86.
6. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap L, Wenstrom KD. Williams Obstetrics. 2005. 22nd ed. New York: McGraw-Hill Professional.
7. Macphail C, Fitzgerald J. Massive post-partum haemorrhage. Curr Opin Obstet Gynecol. 2001. 11:108–114.
Article
8. Katesmark M, Brown R, Raju KS. Successful use of a Sengstaken-Blakemore tube to control massive postpartum haemorrhage. Br J Obstet Gynaecol. 1994. 101:259–260.
Article
10. Schnarwyler B, Passweg D, von Castelberg B. Successful treatment of drug refractory uterine atony by fundus compression sutures. Gerbultshilfe Frauenheilkd. 1996. 56:151–153.
11. B-Lynch C, Coker A, Lawal AH, Abu J, Cowen MJ. The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol. 1997. 104:372–375.
Article
12. Hayman RG, Arulkumaran S, Steer PJ. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol. 2002. 99:502–506.
Article
13. Park RC, Duff WP. Role of cesarean hysterectomy in modern obstetric practice. Clin Obstet Gynecol. 1980. 23:601–620.
Article
14. Cosgriff N, Moore EE, Sauaia A, Kenny-Moynihan M, Burch JM, Galloway B. Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited. J Trauma. 1997. 42:857–861.
15. Hardy JF, De Moerloose P, Samama M. Groupe d'intérêt en Hémostase Périopératoire. Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Can J Anaesth. 2004. 51:293–310.
Article
16. Hardy JF, de Moerloose P, Samama CM. The coagulopathy of massive transfusion. Vox Sang. 2005. 89:123–127.
Article
17. Hirshberg A, Dugas M, Banez EI, Scott BG, Wall MJ Jr, Mattox KL. Minimizing dilutional coagulopathy in exsanguinating hemorrhage: a computer simulation. J Trauma. 2003. 54:454–463.
Article
18. Armand R, Hess JR. Treating coagulopathy in trauma patients. Transfus Med Rev. 2003. 17:223–231.
Article
19. Leslie SD, Toy PT. Laboratory hemostatic abnormalities in massively transfused patients given red blood cells and crystalloid. Am J Clin Pathol. 1991. 96:770–773.
Article
20. Reiss RF. Hemostatic defects in massive transfusion: rapid diagnosis and management. Am J Crit Care. 2000. 9:158–165.
Article
21. Slichter SJ. Identification & management of defects in platelet hemostasis in massively transfused patients. Prog Clin Biol Res. 1982. 108:225–258.
22. Practice Guidelines for blood component therapy: a report by the American Society of Anesthesiologists Task Force on Blood Component Therapy. Anesthesiology. 1996. 84:732–747.
23. Samama CM, Djoudi R, Lecompte T, Nathan-Denizot N, Schved JF. Agence Française de Sécurité Sanitaire des Produits de Santé expert group. Perioperative platelet transfusion: recommendations of the Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSaPS) 2003. Can J Anaesth. 2005. 52:30–37.
Article
24. Vaslef SN, Knudsen NW, Neligan PJ, Sebastian MW. Massive transfusion exceeding 50 units of blood products in trauma patients. J Trauma. 2002. 53:291–295.
Article
25. Malone DL, Hess JR, Fingerhut A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma. 2006. 60:S91–S96.
Article
26. Yamashita Y, Harada M, Yamamoto H, Miyazaki T, Takahashi M, Miyazaki K, et al. Transcatheter arterial embolization of obstetric and gynaecological bleeding: efficacy and clinical outcome. Br J Radiol. 1994. 67:530–534.
Article
27. Lédée N, Ville Y, Musset D, Mercier F, Frydman R, Fernandez H. Management in intractable obstetric haemorrhage: an audit study on 61 cases. Eur J Obstet Gynecol Reprod Biol. 2001. 94:189–196.
Article
28. Kirsop R, Jakubowicz D. Management of haemorrhage in a case of acute fatty liver of pregnancy by internal iliac artery embolisation. Br J Obstet Gynaecol. 1992. 99:1014–1016.
Article
31. Collins CD, Jackson JE. Pelvic arterial embolization following hysterectomy and bilateral internal iliac artery ligation for intractable primary post partum haemorrhage. Clin Radiol. 1995. 50:710–713.
Article
32. Oei PL, Chua S, Tan L, Ratnam SS, Arulkumaran S. Arterial embolization for bleeding following hysterectomy for intractable postpartum hemorrhage. Int J Gynaecol Obstet. 1998. 62:83–86.
Article
33. Plauché WC, Gruich FG, Bourgeois MO. Hysterectomy at the time of cesarean section: analysis of 108 cases. Obstet Gynecol. 1981. 58:459–464.
34. Noris M, Remuzzi G. Uremic bleeding: closing the circle after 30 years of controversies? Blood. 1999. 94:2569–2574.
Article
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