New methods may halt postpartum hemorrhage: compression by sutures, garments.
Military antishock trousers (MAST) placed on women in severe hemorrhagic shock restored blood pressure and improved mental status within 5 minutes in five of the six patients, physicians in Pakistan reported recently. When the trousers were left on for 4-8 hours, bleeding stopped completely in all six women (BJOG 109:1377-84, 2002).
This technique is one of several recent innovations in the treatment of postpartum hemorrhage; the innovations provide more options for avoiding hysterectomy and preserving fertility, Dr. Maurice L. Druzin said at a meeting on antepartum and intrapartum management.
If postpartum hemorrhage does not respond to bimanual compression or pharmacologic therapy, consider one of these alternatives before resorting to hysterectomy, he said at the meeting, sponsored by the University of California, San Francisco:
* MAST. The stretch neoprene trousers with Velcro fasteners apply 20-40 mm Hg of pressure to the lower body without pumps, gauges, or valves. The trousers have been used mainly to manage hypovolemic shock.
Each pair costs a mere $150 and can be reused up to 100 times. Despite the low cost, "I'm having trouble convincing my administration to buy one," said Dr. Druzin, chief of maternal-fetal medicine and professor of gynecology/obstetrics at Stanford (Calif.) University.
* Uterine packing. Once discouraged because it was believed to be an ineffective therapy that could cause infection, uterine packing has made a comeback. "Many anecdotal reports say packing does work,'" and it preserves fertility, he said.
* Balloon tamponade. Several case reports suggest that a balloon inflated with saline can be inserted into the uterine cavity with a Foley catheter or Sengstaken-Blakemore tube. The balloon is left in place for 12-24 hours. "It's another quick way of packing" and is a reasonable option before more drastic treatments, he said.
* Angiography. Occasionally, pelvic arterial embolization can be a good option for patients who want to preserve fertility. "We've developed an excellent relationship with our interventional radiologists. They can get there within half an hour while we do other measures," Dr. Druzin said.
Increasingly, he is having them place arterial catheters prophylactically to prepare for embolization if necessary in patients at high risk for postpartum hemorrhage, such as those with placenta previa or placenta accreta.
* B-Lynch suture. Dr. Druzin has not tried this latest alternative to hysterectomy but "my associate said it's real easy," he commented. The technique involves compression sutures and was successful in several small case series. In the most recent series, B-Lynch suture stopped severe postpartum hemorrhage resulting from atony at the time of cesarean section in six of seven patients (J. Obstet. Gynaecol. Can. 25: 197-200, 2003).
"I think the B-Lynch is here to stay. It's something to try," Dr. Druzin said. In addition to these newer treatments, the more traditional surgical alternatives of uterine artery ligation or hysterectomy will stop postpartum hemorrhage.
Dr. Druzin cautioned against using another surgical approach that had gained some popularity but now is believed to be dangerous--ligation of the hypogastric (internal iliac) artery. Although the procedure is still included as a treatment option on obstetric board exams, general obstetricians shouldn't try it without a pelvic surgeon or oncologist present to avoid damaging the hypogastric vein.
BY SHERRY BOSCHERT San Francisco Bureau
|Printer friendly Cite/link Email Feedback|
|Publication:||OB GYN News|
|Date:||Oct 15, 2003|
|Previous Article:||Screen for fetal hyperthyroidism at 24-26 weeks: Graves' disease.|
|Next Article:||Data Bank tracks fraud convictions, exclusions: up and running for 4 years.|