Die operative Behandlung von schweren atonischen Nachblutungen mit Uterus-Kompressionsnähten in Anlehnung an Pereira

 

 Buy Article Permissions and Reprints

Zusammenfassung

Hintergrund und Fragestellung: Die postpartale Blutung ist eine der Hauptursachen für die maternale Mortalität. Nach Versagen der medikamentösen Therapie stellt das von Pereira beschriebene uteruserhaltende operative Vorgehen eine sinnvolle Alternative zur Hysterektomie dar.

Material und Methodik: Der Uterus wird durch mehrere oberflächlich gestochene horizontal und longitudinal geführte Fäden komprimiert. Zusätzlich wird die uterine Durchblutung reduziert.

Ergebnisse: Fünf Frauen, die im Rahmen einer Sektio trotz medikamentöser Therapie mit Oxytocin und Sulproston eine schwere Atonie entwickelten, wurden durch Kompressionsnähte in Anlehnung an Pereira erfolgreich uteruserhaltend behandelt. Der postoperative Verlauf war unkompliziert.

Schlussfolgerung: Das uteruserhaltende Verfahren mit Uteruskompressionsnähten nach Pereira ist ein vergleichsweise einfaches und zügig durchzuführendes Verfahren zur operativen Behandlung medikamentös refraktärer postpartaler Atonien.

Abstract

Background: Postpartum haemorrhage is an important cause of maternal mortality. After failure of medical treatment, the application of uterine compressive sutures as described by Pereira to treat postpartum bleeding is an alternative to hysterectomy.

Material and Methods: The uterus is compressed by multiple, superficially inserted sutures which are applied transversally and longitudinally around the uterus. Additionally the vascular flow is reduced.

Results: Five women underwent a Caesarean section and, in spite of treatment with oxytocin and sulprostone developed severe postpartum haemorrhage. Compression sutures of the uterus as described by Pereira were successful in all cases. The follow-up was uneventful in all cases.

Conclusion: Compressive sutures of the uterus as described by Pereira are easy and quick to perform for treating uterine atony with postpartum bleeding.

Literatur

• 1 WHO .The prevention and management of postpartum haemorrhage. WHO report of technical working group. Geneva: World Health Organization; 1990. Report No. WHO / MCH / 90.7
  Google Scholar
• 2 Abouzahr C. Antepartum and postpartum haemorrhage. In: Health dimensions of sex and reproduction. Harvard University Press, Boston, USA 1998; 172-174
  Google Scholar
• 3 Winkler M, Rath W. Postpartale Blutungen.  Der Gynäkologe. 1998;  31 184-192
  CrossrefPubMedGoogle Scholar
• 4 Gilstrap L C, Ramin S M. Postpartum hemorrhage.  Clin Obstet Gynecol. 1994;  37 824-830
  PubMedGoogle Scholar
• 5 Varner M. Postpartum hemorrhage.  Crit Care Clin. 1991;  7 883-897
  PubMedGoogle Scholar
• 6 Burchell R C. Postpartum haemorrhage. In: Quilligan ES (ed). Current therapy in obstetrics and gynaecology. Saunders, Philadelphia, PA 1980
  Google Scholar
• 7 American College of Obstetricians and Gynecologists .Postpartum hemorrhage. ACOG Educational bulletin Number 243. American College of Obstetricians and Gynecologists, Washington, DC 1998
  Google Scholar
• 8 Combs C A, Murphy E L, Laros Jr R K. Factors associated with postpartum hemorrhage with vaginal birth.  Obstet Gynecol. 1991;  77 69-76
  PubMedGoogle Scholar
• 9 Stones R W, Paterson C M, Saunders N J. Risk factors for major obstetric haemorrhage.  Eur J Obstet Gynecol Reprod Biol. 1993;  48 15-18
  CrossrefPubMedGoogle Scholar
• 10 Bonnar J. Massive obstetric haemorrhage.  Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;  14 1-18
  CrossrefPubMedGoogle Scholar
• 11 Prasertcharoensuk W, Swadpanich U, Lumbiganon P. Accuracy of the blood loss estimation in the third stage of labor.  Int J Gynaecol Obstet. 2000;  71 69-70
  CrossrefPubMedGoogle Scholar
• 12 Pereira A, Nunes F, Pedroso S, Saraiva J, Retto H, Meirinho M. Compressive uterine sutures to treat postpartum bleeding secondary to uterine atony.  Obstet Gynecol. 2005;  106 569-572
  CrossrefPubMedGoogle Scholar
• 13 Alvarez M, Lockwood C J, Ghidini A D, Ghidiniottino P, Mitty H A, Berkowitz R L. Prophylactic and emergent arterial catheterization for selective embolization in obstetric hemorrhage.  Am J Perinatol. 1992;  9 441-444
  PubMedGoogle Scholar
• 14 Maier R C. Control of postpartum haemorrhage with uterine packing.  Am J Obstet Gynecol. 1993;  169 317-323
  PubMedGoogle Scholar
• 15 Mischler C, Hänggi W, Schneider H. Die Uterustamponade als einfache und effiziente Therapie der schweren postpartalen Blutung.  Geburtshilfe Frauenheilkd. 1997;  57 305-309
  PubMedGoogle Scholar
• 16 O'Leary J L, O'Leary J A. Uterine artery ligation for control of postcesarean section hemorrhage.  Obstet Gynecol. 1974;  43 849-853
  PubMedGoogle Scholar
• 17 AbdRabbo S A. Stepwise uterine devascularisation: a novel technique for management of uncontrollable postpartum hemorrhage with preservation of the uterus.  Am J Obstet Gynecol. 1994;  171 694-700
  PubMedGoogle Scholar
• 18 B-Lynch C, Coker A, Lawal A H, Abu J, Cowen M J. The B-Lynch surgical technique for the control of massive haemorrhage: an alternative to hysterectomy? Five cases reported.  Br J Obstet Gynaecol. 1997;  104 372-375
  CrossrefPubMedGoogle Scholar
• 19 Cho J H, Jun H S, Lee C N. Hemostatic suturing technique for uterine bleeding during cesarean delivery.  Obstet Gynecol. 2000;  96 129-131
  CrossrefPubMedGoogle Scholar
• 20 Hayman R G, Arulkumaran S, Steer P J. Uterine compression sutures: surgical management of postpartum hemorrhage.  Obstet Gynecol. 2002;  99 502-506
  CrossrefPubMedGoogle Scholar
• 21 Ouahba J, Piketty M, Huel C, Azarian M, Feraud O, Luton D, Sibony O, Oury J F. Uterine compression sutures for postpartum bleeding with uterine atony.  BJOG. 2007;  114 619-622
  PubMedGoogle Scholar
• 22 Doumouchtsis S K, Papageorghiou A T, Arulkumaran S. Systematic Review of Conservative Management of Postpartum Hemorrhage: What to Do When Medical Treatment Fails.  Obstet Gynecol Surv. 2007;  62 540-547
  CrossrefPubMedGoogle Scholar
• 23 Joshi V M, Shrivastava M. Partial ischemic necrosis of the uterus following uterine brace compression suture.  BJOG. 2004;  111 279-280
  CrossrefPubMedGoogle Scholar
• 24 Treloar E J, Anderson R S, Andrews H S, Bailey J L. Uterine necrosis following B-Lynch suture for primary postpartum haemorrhage.  BJOG. 2006;  113 486-488
  CrossrefPubMedGoogle Scholar
• 25 Ochoa M, Allaire A D, Stitely M L. Pyometria after hemostatic square suture technique.  Obstet Gynecol. 2002;  99 506-509
  CrossrefPubMedGoogle Scholar
• 26 Baskett T F. Uterine compression sutures for postpartum hemorrhage: efficacy, morbidity, and subsequent pregnancy.  Obstet Gynecol. 2007;  110 68-71
  CrossrefPubMedGoogle Scholar

Dr. med. W. Stein

Zentrum für Frauenheilkunde der Georg-August-Universität Göttingen

Robert-Koch-Straße 40

37075 Göttingen

Email: werner.stein@med.uni-goettingen.de