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Amniotic Fluid Embolism
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Zaid Diken, Antonio F. Saad, Luis D. Pacheco
Uterine atony, when present, should be managed aggressively with the use of uterotonics such as oxytocin, ergot derivatives, and prostaglandins [60]. If medical therapy fails, uterine tamponade with the use of packing or commercially available intra-uterine balloons should be considered. Surgical approaches such as bilateral uterine artery ligation, B-Lynch stitch, or even a hysterectomy may be needed in extreme cases of uterine atony and bleeding.
Primary Postpartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Anything that interferes with the ability of the uterus to contract and retract, causes uterine atony, the most common cause of primary PPH, and accounts for 80%–85% of cases. Risk factors for uterine atony are listed in Table 14.2. However, the majority of cases of uterine atony occur in women with no risk factors. Therefore, primary PPH is largely unpredictable, and every birth attendant should be able to adopt appropriate preventive measures, anticipate and detect excessive bleeding early on and quickly commence appropriate initial management, if it indeed occurs.
Obstetrics in Limited-Resource Settings
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Carlos Pilasi Menichetti, Rebekka Troller
Rapid assessment, resuscitation, and observations (HR, BP, RR) should be undertaken. The patient should lie flat. Uterine atony is treated by bimanual uterine compression and massage, followed by drugs (Oxytocin 20 IU L−1 of normal saline, Carboprost 0.25 mg IM, Misoprostol (Cytotec) 1000 mcg rectally, Methylergonovine 0.2 mg IM). Two large-bore cannulas and blood test should be sent; then the bladder must be catheterised.
How to boost an obstetrician's confidence in vaginal delivery after high-intensity focused ultrasound: a comparison study on delivery outcomes
Published in International Journal of Hyperthermia, 2022
Jinping Gu, Bin Lin, Zhengyu Guo, Aixingzi Aili
Common causes of PPH include uterine atony, trauma, retained placental tissue, and failure of the blood coagulation system, with uterine atony accounting for the majority of cases (75–90%) [32]. Uterine atony is defined as the inability of the uterus to contract after the fetus has been expelled [33]. According to our research, contraction of the uterus is associated with PPH (aOR: 17.177, 95% CI:5.046 ∼ 58.472, p = 0.000), and this finding is consisted with the expert consensus. The rate of using more than two types of uterotonic medications to promote contraction is significantly lower in the Qualified Candidates for TOLAH group (54.05 percent vs 69.84 percent, p = 0.04), and the percentage of abnormal uterine contraction is lower in the Qualified Candidates for TOLAH group (35.14 percent vs 49.18 percent, p = 0.072). We believe that the uterine contraction ability is unaffected by HIFU, which explains the low incidence of PPH after HIFU. The ability of uterine contraction after HIFU has received less attention in prior literature. Only one case of PPH due to uterine atony after HIFU was found in Li's analysis of 93 full-term births [19]. Following HIFU, the reduction of myoma volume or the ablation inside myomas is beneficial to contraction ability. This point of view needs more studies to concentrate on.
Temporary cervical sling and uterine twist before B-Lynch for massive uterine bleeding after delivery
Published in Journal of Obstetrics and Gynaecology, 2022
Basile Pache, Vincent Balaya, David Desseauve
Caesarean section (c-section) is one of the most widely performed surgery procedures. Among the feared complications, massive bleeding may occur due to uterine atony, accreta spectrum or vascular lesions. Prompt reaction to bleeding during surgery will be lifesaving (Hawkins 2020). Although procedures have evolved (Wilson 1945), there is a wide disparity in access to advanced techniques. The simple procedure of cervical sling can be performed by any surgeon when massive uterine bleeding occurs. The purpose of the technique is to be an intermediate step in bleeding control by compression of uterine and descending cervical arteries, in order to provide enough time to both surgical team to call on an experienced surgeon for support and for the anaesthesiologists to stabilise the patient, within good conditions and minimal additional blood loss.
Bakri Balloon: an easy, useful and effective option for the treatment of postpartum haemorrhage
Published in Journal of Obstetrics and Gynaecology, 2022
Maria-Jesús Puente-Luján, Maria-Pilar Andrés-Orós, Leticia Álvarez-Sarrado, Andrea Agustín-Oliva, Isabel González-Ballano, Belén Rodríguez-Solanilla, Sergio Castán-Mateo
PPH management depends on its aetiology. Uterine atony is the most common underlying cause (‘WHO | Trends in Maternal Mortality: 1990 to 2013’ 2018). An early diagnosis and a swift treatment with uterotonic drugs (oxytocin, methylergometrine and prostaglandins) as first-line treatment are vital for the prognosis of the patient. When these fail, before resorting to more invasive procedures such as arterial embolisation or conservative surgical techniques, intrauterine tamponade has been accepted as second-line treatment. The Bakri Balloon (Cook® Medical) has a specific indication for PPH treatment and has been widely recommended as a method of choice by the main scientific associations when medical treatment fails (Dildy et al. 2004; Georgiou 2009; ‘Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52’ 2017; ‘WHO | Trends in Maternal Mortality: 1990 to 2013’ 2018). It's quick, secure and easy handling, which makes it a great alternative even for obstetricians with little experience.