Moussaoui Kamal El, Zraidi Najia, Baidada Aziz, Kharbach Aicha
Département de Gynécologie Obstétrique, Maternité Souissi, CHU Ibn Sina, Rabat, Maroc.
Pan Afr Med J. 2020 Nov 26;37:279. doi: 10.11604/pamj.2020.37.279.26788. eCollection 2020.
Delivery hemorrhage is the leading cause of maternal mortality in Morocco. It is an obstetric emergency requiring early, effective and multidisciplinary management in patients with severe postpartum bleeding resistant to medical treatment. Advances in interventional radiology and especially, in surgical techniques have provided safe and effective alternatives to hemostasis hysterectomy . We here report a case of uterine necrosis following conservative surgical treatment of delivery hemorrhage based on B-Lynch uterine compression suture combined with Tsirulnikov triple vascular ligation. The patient had sepsis on day 4 after delivery associated with fever and pelvic pain and biological inflammatory syndrome which worsened 48 hours after the onset of abdominal contracture. Abdomopelvic scanner, showed gas bubbles in the uterine myometer suggestive of necrosis. Exploratory laparotomy was performed, which objectified complete necrosis of the uterus. Uterine compression sutures are surgical techniques which play a major role in the therapeutic armamentarium of postpartum hemorrhage during cesarean section. It allows, in addition to or as an alternative to vascular ligation, the preservation of patient's fertility, but it also requires maximum caution and monitoring of complications, the most serious of which is uterine necrosis.
分娩出血是摩洛哥孕产妇死亡的主要原因。它是一种产科急症，对于药物治疗无效的严重产后出血患者需要进行早期、有效且多学科的管理。介入放射学的进展，尤其是手术技术的进步，为子宫切除止血提供了安全有效的替代方法。我们在此报告一例基于B-Lynch子宫压迫缝合联合齐鲁尔尼科夫三重血管结扎术对分娩出血进行保守手术治疗后发生子宫坏死的病例。该患者在分娩后第4天出现败血症，伴有发热和盆腔疼痛以及生物炎症综合征，在腹部挛缩发作48小时后病情恶化。腹盆腔扫描显示子宫肌层有气泡，提示坏死。进行了剖腹探查术，证实子宫完全坏死。子宫压迫缝合术是剖宫产术中产后出血治疗手段中的一项重要手术技术。除血管结扎外或作为血管结扎的替代方法，它能保留患者的生育能力，但也需要格外小心并监测并发症，其中最严重的是子宫坏死。
