Condous George Stanley, Arulkumaran Sabaratnam
Division of Obstetrics and Gynaecology, St George's Hospital Medical School, London, England.
J Obstet Gynaecol Can. 2003 Nov;25(11):931-6. doi: 10.1016/s1701-2163(16)30241-9.
Massive postpartum hemorrhage (PPH) is a major cause of maternal mortality in the United Kingdom and worldwide. Life-threatening PPH occurs with a frequency of 1 in 1000 deliveries in the developed world. In the latest triennial Why Mothers Die: Confidential Enquiries into Maternal Deaths in the United Kingdom (1997-1999), PPH was the fifth most common cause of maternal mortality. In this review, we discuss the role of medical management in primary PPH and the use of the "tamponade test" when such management fails. The less radical surgical options discussed include uterine compression sutures, uterine or internal iliac artery ligation, and arterial embolization, all of which have the advantage of potentially preserving reproductive function. Radical surgical options, including subtotal or total hysterectomy, are not discussed in this review. A systematic or algorithmic method of tackling the problem is described. The suggested management approach is likely to reduce maternal morbidity from bleeding, hysterectomies, and maternal deaths.
在英国及全球范围内，产后大出血（PPH）是孕产妇死亡的主要原因。在发达国家，危及生命的产后大出血发生率为千分之一。在最新的英国孕产妇死亡保密调查（1997 - 1999年）三年期报告中，产后大出血是孕产妇死亡的第五大常见原因。在本综述中，我们讨论了药物治疗在原发性产后大出血中的作用，以及在这种治疗失败时“压迫试验”的应用。文中讨论的创伤性较小的手术选择包括子宫压迫缝合术、子宫或髂内动脉结扎术以及动脉栓塞术，所有这些方法都具有潜在保留生殖功能的优势。本综述未讨论包括次全或全子宫切除术在内的根治性手术选择。本文描述了一种系统的或算法式的解决该问题的方法。所建议的管理方法可能会降低因出血、子宫切除和孕产妇死亡导致的孕产妇发病率。
