Obstetrics and Gynecology Advances: Postpartum Hemorrhage and Cesarean Section: Complications of Labor and Delivery (PDF)

In this collection, a combined method of preventing and stopping a postpartum obstetric hemorrhage is proposed, involving surgical hemostasis by ligation of the descending branch of the uterine artery and placement of a hemostatic external supraplacental pleated suture, as well as mechanical compression of the uterine cavity with both vaginal and uterine Zhukovsky catheters, and coagulopathy management using thromboelastography (TEG). Uterine hemostatic sutures and their advantages and disadvantages are described in detail, and the benefits of the innovative external supraplacental pleated suture are discussed. Intrauterine balloon tamponade (IUBT) devices have been shown to to be an effective management for severe postpartum hemorrhage (PPH) resulting from uterine atony as well as placental site bleeding. IUBT have now been incorporated into standard protocols for management of severe PPH as a second line conservative surgical procedure due to its simplicity and relatively non-invasive nature. In recent decades, the use of second line procedures has rapidly increased and the effectiveness of these second-line procedures in reducing hysterectomy has been demonstrated in literature. Among these various second line procedures, the use of uterine balloon tamponade increased most rapidly. Balloon tamponade is less invasive and easier to apply than other second line management. Intrauterine balloon tamponade should probably be the first second-line procedure to consider in management of severe PPH. Lastly, the book discusses how anesthesia in pregnant women with rare diseases is challenging. Because of the low occurrence and heterogeneity of these diseases, most anesthesiologists are not familiar with the symptomatology, associated comorbidities, and their consequences for anesthesia. The authors suggest that peroperative monitoring should primarily focus on the cardiopulmonary system, the depth of the neuromuscular block, and the core temperature. Because of the high risk of respiratory depression following general anesthesia in patients with rare diseases, these patients should be closely monitored during the postoperative period, with an emphasis on complete reversal of neuromuscular blockade.