Cases reported "Uterine Inertia"

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1/9. Surgical treatment of uterine atony employing the B-Lynch technique.

    postpartum hemorrhage remains a major cause of maternal morbidity and mortality. Four cases utilizing the B-Lynch technique for control of hemorrhage secondary to uterine atony are presented. The B-Lynch technique appears to be effective in controlling postpartum hemorrhage. More experience is needed before the B-Lynch technique can be accepted as routine practice. ( info)

2/9. Successful treatment of life-threatening postpartum hemorrhage with recombinant activated factor VII.

    BACKGROUND: postpartum hemorrhage is one of the most common causes of maternal mortality and morbidity worldwide. The aims of treatment are to maintain the circulation and to stop the bleeding. The latter is achieved by either medical or surgical management. In intractable bleeding, emergency hysterectomy is usually required. CASE: A 30-year-old nullipara presented with major postpartum hemorrhage due to uterine atony and vaginal lacerations. The patient developed hemorrhagic shock, resulting in prolonged prothrombin time, prolonged activated partial thromboplastin time, and low levels of factor viii and fibrinogen. Treatments with uterotonic drugs, suturing, ligation of internal iliac arteries, subtotal hysterectomy, packing of the pelvis, and blood transfusion failed to control diffuse pelvic and vaginal bleeding. Recombinant activated factor viia (60-microg/kg intravenous bolus injection) was given as a final attempt to control the bleeding. The bleeding was successfully controlled within 10 minutes after administration. No side effects were noted. CONCLUSION: Recombinant factor VIIa may be an alternative hemostatic agent in a patient with life-threatening postpartum hemorrhage unresponsive to conventional therapy. ( info)

3/9. Inadvertent administration of prostaglandin E1 instead of prostaglandin F2 alpha in a patient with uterine atony and hemorrhage.

    A woman underwent cesarean delivery for premature labor, breech presentation, and ruptured membranes. placenta accreta associated with uterine atony and severe hemorrhage was diagnosed. Prostaglandin E1 instead of prostaglandin F2 alpha was inadvertently administered in an effort to control the hemorrhage. The resulting complications included profound hypotension, disseminated intravascular coagulation, and ventricular tachycardia. ( info)

4/9. fertility after B-Lynch suture and hypogastric artery ligation.

    OBJECTIVE: To report a case of successful pregnancy after hypogastric artery ligation and the B-Lynch brace suturing technique. DESIGN: Case report. SETTING: education and research hospital. PATIENT(S): A 22-year-old woman, whose first pregnancy was terminated by cesarean section owing to abruptio placenta and intrauterine fetal demise diagnosed at the 26th week of gestation, referred to our clinic for uterine atony. INTERVENTION(S): Hypogastric artery ligation and the B-Lynch brace suturing technique. MAIN OUTCOME MEASURE(S): Clinical pregnancy and live birth. RESULT(S): Two years after the surgery, the patient conceived spontaneously and delivered a healthy infant after an uneventful pregnancy. CONCLUSION(S): This is the first reported case of successful pregnancy after hypogastric artery ligation and B-Lynch suturing technique. This life-saving therapeutic option for severe postpartum hemorrhage appears to be a safe procedure that does not impair subsequent fertility and pregnancy outcomes. The B-Lynch suturing technique seems to be simple and has the capability of preserving the uterus; therefore it may be considered as the first-line surgical treatment for uterine atony before considering hysterectomy. ( info)

5/9. Treatment of postpartum uterine atony with prostaglandin E2 vaginal suppositories.

    When severe postpartum hemorrhage secondary to uterine atony is unresponsive to medical management, including oxytocic drugs and/or ergonovine and its derivatives, surgical intervention becomes necessary. This case of postpartum uterine atony, with several features suggesting persistent myometrial dysfunction which did not respond to usual medical measures, responded to treatment with intravaginal prostaglandin E2 (PGE2) suppositories. Prostaglandin E2 vaginal suppositories may be useful in the treatment of persistent postpartum uterine atony. ( info)

6/9. Control of postpartum uterine atony by intramyometrial prostaglandin.

    Five patients with severe postpartum hemorrhage due to uterine atony and unresponsive to oxytocin, ergonovine, and massage were treated with intramyometrial injection of 250 micrograms of prostaglandin (15S)-15-methyl PGF2 alpha-Tham. Four patients received 2 injections (500 micrograms), and 1 patient required 1 injection (250 micrograms). Three (60%) of 5 patients responded successfully with an increase in uterine tone and cessation of uterine hemorrhage, thus obviating the need for hysterectomy. Two patients had no uterine response, possibly because of delayed use of the drug, excessive blood loss, and accompanying shock; they required hysterectomy. Intramyometrial injection of prostaglandin is an effective and safe method of managing severe postpartum hemorrhage unresponsive to oxytocin and ergonovine, but it must be used early during the management of atony to obtain maximum effect. This method should precede surgical management of uterine atony. ( info)

7/9. Reproductive significance of changes in the endometrial cavity associated with exposure in utero to diethylstilbestrol.

    ( info)

8/9. Vaginal ligature of uterine arteries during postpartum hemorrhage.

    Immediate postpartum hemorrhage due to uterine inertia is usually treated by injection of oxytocics. In some situations, bleeding continues and distends the uterine cavity, in turn disturbing the hemostasis that accompanies uterine retraction. Uterine bleeding must be rapidly reduced while the coagulation defect is corrected. The authors propose the vaginal ligature of uterine arteries, which can be performed in the delivery room, as an alternative to hysterectomy. ( info)

9/9. Bimanual uterine compression as a major technique in controlling severe postpartum hemorrhage from uterine atony.

    A 27-year old woman, primigravida, 33 weeks' gestation, presented with complaints of labor pain and absent fetal movement. A dead fetus in utero, abruptio placentae, and labor pain were diagnosed. Severe postpartum hemorrhage from uterine atony and disseminated intravascular cogulopathy was noted after spontaneous delivery of the baby and placenta. Bimanual uterine compression for 40 minutes was performed as a major procedure accompanied by uterotonic drugs, correction of hypovolemic shock and coagulopathy by crytalloid, blood, fresh frozen plasma. The patient had no complications when seen at 6 weeks' postpartum follow-up. ( info)


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