Hackethal A, Tcharchian G, Ionesi-Pasacica J, Muenstedt K, Tinneberg H R, Oehmke F
Department of Obstetrics and Gynecology, Justus-Liebig-University of Giessen, Giessen, Germany.
Minerva Ginecol. 2009 Jun;61(3):201-13.
Uterine atony accounts for the majority of primary postpartum hemorrhage. Timely recognition and intervention are fundamental in preventing serious maternal morbidity and mortality. Combinations of conservative manual and medical therapies are adequate and successful treatment options in most cases. However, when the hemorrhagic process continues and when either clotting abnormalities or hemodynamic instability develop, the next step must be an invasive intervention. Depending on the mode of delivery a vaginal approach (i.e. curettage and uterine packing) after spontaneous delivery or an abdominal surgical approach (i.e. compression sutures and systematic devascularization) after a Cesarean delivery can be performed. Uterine compression sutures are especially highly effective and a straightforward and easy emergency procedure which conserves fertility. The ultima ratio in all cases of persistent haemorrhage after conservative and uterus preserving surgical therapy is the emergent hysterectomy. It might be of advantage to perform a subtotal or supracervical hysterectomy compared to a total hysterectomy in an emergency setting.
子宫收缩乏力是原发性产后出血的主要原因。及时识别和干预是预防严重孕产妇发病和死亡的根本。在大多数情况下，保守的手法和药物联合治疗是充分且成功的治疗选择。然而，当出血过程持续，且出现凝血异常或血流动力学不稳定时，下一步必须进行侵入性干预。根据分娩方式，顺产之后可采用阴道途径（如刮宫术和子宫填塞），剖宫产之后可采用腹部手术途径（如压迫缝合和系统性血管结扎）。子宫压迫缝合术特别有效，是一种直接且简便的紧急手术，可保留生育能力。在保守治疗和保留子宫的手术治疗后，所有持续性出血病例的最终手段是紧急子宫切除术。在紧急情况下，与全子宫切除术相比，次全子宫切除术或宫颈上子宫切除术可能更具优势。
