Surgical treatments for postpartum hemorrhages
Seance of wednesday 02 april 2025 (Chirurgie Humanitaire et solidaire)
DOI number : 10.26299/gk8z-z919/2025.13.03
Abstract
Postpartum hemorrhages remain one of the scourges of Obstetrics for obstetricians and midwives, and yet, we have the means to reduce their frequency, severity and morbidity.
Severe hemorrhages correspond to hemorrhages requiring a hemostatic procedure or transfusion. They represent 25% of the causes of maternal mortality and occur in 1 to 3/1000 births. Screening and early management of postpartum hemorrhages should reduce the incidence of severe hemorrhages.
In the event of severe hemorrhages, the strategy is to avoid mortality and reduce morbidity.
Management is of course multidisciplinary with our anesthesiologist colleagues.
Hysterectomy is effective if performed at an adequate stage but it induces morbidity, particularly in primiparous women or those who do not have a living child.
Conservative methods have been developed such as uterine artery embolization.
In some countries and regions of the world, this method is not accessible 24/7.
Simple surgical techniques can avoid hysterectomy in most cases.
There are two types of techniques: vascular ligatures, uterine retraction techniques and finally the combination of the two (Pereira technique).
Both techniques are effective but vascular ligatures require more training with potential perioperative risks, including ureteral injuries.
Retraction techniques are effective and very easy to learn. They have already shown their impact in difficult situations and should be widely disseminated.
Severe hemorrhages correspond to hemorrhages requiring a hemostatic procedure or transfusion. They represent 25% of the causes of maternal mortality and occur in 1 to 3/1000 births. Screening and early management of postpartum hemorrhages should reduce the incidence of severe hemorrhages.
In the event of severe hemorrhages, the strategy is to avoid mortality and reduce morbidity.
Management is of course multidisciplinary with our anesthesiologist colleagues.
Hysterectomy is effective if performed at an adequate stage but it induces morbidity, particularly in primiparous women or those who do not have a living child.
Conservative methods have been developed such as uterine artery embolization.
In some countries and regions of the world, this method is not accessible 24/7.
Simple surgical techniques can avoid hysterectomy in most cases.
There are two types of techniques: vascular ligatures, uterine retraction techniques and finally the combination of the two (Pereira technique).
Both techniques are effective but vascular ligatures require more training with potential perioperative risks, including ureteral injuries.
Retraction techniques are effective and very easy to learn. They have already shown their impact in difficult situations and should be widely disseminated.