Interventional treatment of intractable postpartum hemorrhage

by ncpimqudxsx on 2012-02-29 10:26:56

Interventional treatment of intractable postpartum hemorrhage: The venous phase. In the arterial phase, the spill-over of contrast agents can be more clearly observed; during the venous phase, the retention of contrast agent in the uterine cavity makes the diagnosis clearer. Therefore, first, through femoral artery angiography, bleeding sites can be clearly identified, as well as whether the blood vessels supplying them are unilateral or bilateral. Moreover, angiography can clearly show the trend and characteristics of pelvic blood vessels, which serves as a further basis for catheterization of the internal iliac artery or uterine artery, improving the accuracy of intubation, shortening the intubation time, and providing valuable time to rescue critically ill patients with postpartum hemorrhage. Most cases of postpartum hemorrhage (3.2) have achieved successful hemostasis through conservative treatment methods. The traditional method involves performing hysterectomy or internal iliac artery ligation for a small number of refractory postpartum hemorrhage cases where conservative treatment fails. For postpartum hemorrhage patients aged 20-30 years, surgical removal means permanent loss of the uterus. The uterus is not just a reproductive organ but also has important endocrine functions. Since the ovarian blood supply is 50% to 70% from the ovarian branch of the sub-rich artery, hysterectomy will inevitably affect the endocrine function of the ovaries, impacting women's physical and mental health. Double internal iliac artery ligation has low technical difficulty for hemostasis but a low success rate, with an effective rate reported at 42%. UAE technology is relatively simple, safe, and effective in stopping bleeding quickly with few complications. Through cholangiography, there is an accurate understanding of pelvic arterial bleeding sites and bleeding, allowing selective blockage of blood vessels with a high success rate (in this paper, a success rate of 91.9%). The application of this method, especially for young patients, avoids hysterectomy and preserves reproductive function. Shock patients can tolerate surgery while correcting shock simultaneously, making it a new and effective method for treating refractory postpartum hemorrhage. This involvement in the treatment of postpartum hemorrhage represents a revolution in its treatment and should be widely applied under hospital conditions. Postpartum hemorrhage occurs 24 hours after the baby is delivered when the amount of vaginal bleeding exceeds 500ml. Bleeding exceeding 1000ml or combined with shock can be diagnosed as severe postpartum hemorrhage. Interventional treatment for severe postpartum hemorrhage should be performed as soon as possible. Interventional treatment has incomparable advantages: Firstly, it only requires local anesthesia and has a short operation time, which is crucial in time-sensitive rescues; immediate hemostatic effect while retaining the uterus and its functions. However, in county and township health centers, refractory postpartum hemorrhage still leads to hysterectomy, resulting in loss of reproductive function and even lives. Therefore, accelerating the use of interventional treatment in intractable postpartum hemorrhage is particularly important. Note: It should be clear that not all postpartum hemorrhages are suitable for interventional therapy. Surgical timing is very important. Most patients achieve hemostasis purposes after appropriate conservative treatment. Only in the case of conservative treatment failure should interventional therapy be chosen to achieve desired results. However, it must be noted that when patients' vital signs are extremely unstable, moving them for DIC late systemic bleeding makes interventional treatment inappropriate. Shock patients should have their volume added to correct the shock while undergoing intervention therapy. Additionally, if the uterine blood supply is obviously unilateral, i.e., under normal circumstances, the side of the uterine artery supplies the ipsilateral uterine body, and usually most of the central palace traffic is closed, unable to supply blood in the contralateral uterine artery under the traffic branch being open, supplying the contralateral uterus. Thus, embolization of only one side of the uterine artery easily leads to failure. One case in this article failed due to embolism on one side, leading to hysterectomy and subtotal resection. After the operation, the puncture site should be bandaged to prevent hematoma caused by puncture point bleeding, but the elastic bandage must be moderate to avoid affecting venous return. Anti-inflammatory treatment should be strengthened for patients to prevent infection after embolism.