Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille (APHM), Hôpital Nord, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
Arch Gynecol Obstet. 2012 Apr;285(4):925-30. doi: 10.1007/s00404-011-2083-7. Epub 2011 Sep 20.
To further study the efficacy of uterine-sparing procedures based on triple uterine artery ligation (TUAL) possibly complemented with hemostatic multiple square suturing (HMSS) for the management of post-partum hemorrhage (PPH).
Cases of PPH occurring during cesarean section and treated, according to our institution guidelines, by TUAL possibly complemented with HMSS between 2000 and 2009 were retrospectively analyzed.
Fifty-six patients were included; 13 (23.2%) had TUAL only, while 43 (76.8%) had additional HMSS performed. Surgical conservative management of PPH was effective in 51 (91.1%) cases. PPH due to placenta accreta, either unanticipated or after failure of conservative management, showed an independent and significant impact on the risk of failure of the procedure (AOR 15.07, 95% CI 1.12-201.9, p = 0.041).
Obstetricians should be aware that a higher risk of failure of the procedure is to be expected in cases of PPH due to placenta accreta. In such situation, to avoid any useless delay in management, our findings suggest that peripartum hysterectomy should be immediately considered.
进一步研究基于三重子宫动脉结扎（TUAL）联合止血多点缝合（HMSS）的保留子宫手术对产后出血（PPH）的疗效。
回顾性分析了 2000 年至 2009 年期间，根据我院指南，对接受 TUAL 联合 HMSS 治疗的剖宫产术中发生的 PPH 病例进行分析。
共纳入 56 例患者，其中 13 例（23.2%）仅行 TUAL，43 例（76.8%）行 HMSS 附加缝合。51 例（91.1%）患者通过手术保守治疗成功止血。胎盘植入导致的 PPH，无论是意料之外还是保守治疗失败后，都会显著增加手术失败的风险（OR 15.07，95%CI 1.12-201.9，p=0.041）。
产科医生应意识到，由于胎盘植入导致的 PPH 手术失败的风险更高。在这种情况下，为避免管理上的任何无效延误，我们的研究结果表明，应立即考虑行围产期子宫切除术。
