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Abstract
Objective
To analysis the 10 cases of relaparotomy for intractable hemorrhage after emergency postpartum hysterectomy with massive transfusion.
Methods
Between January 1995 and December 2008, relaparotomies for intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy with massive transfusion were performed on 10 patients. Medical records were reviewed and detailed to collect clinical data including patients' clinical status, causes of bleeding, duration from hysterectomy to relaparotomy, bleeding sites, procedures for bleeding control, amount of transfusions, complications and prognosis.
Results
In relaparotomies, the points of bleeding were identified in all cases and multiple bleeding foci than one bleeding focus were found, and procedures for bleeding control were performed. In 8 cases, the bleeding were controlled successfully and these patients recovered without long term sequales. But in the other 2 cases, although the bleeding controls were successful during relaparotomy and bleeding amount decreased after relaparotomy, but bleeding amount increased the next day and angiographic embolizations were performed. These patients died due to multi-organ failure and continued bleeding. In one of these cases, the endotracheal intubation had been done on arrival at our hospital with postpartum hemorrhage after vaginal delivery at private clinic. In another case, the cardiopulmonary resuscitation was performed on arriving at our hospital with intractable bleeding after postpartum subtotal hysterectomy in other hospital.
Conclusion
In most cases, bleeding controls for intractable bleeding after postpartum hysterectomy were successful during and after relaparotomy in spite of development of dilutional coagulopthy due to massive transfusion, and resulted in rapid recovery and good prognosis. Even though dilutional coagulopthy was developed because of massive transfusion, relaparotomy was safe and effective procedure for management of intractable hemorrhage after emergency postpartum hysterectomy with clotting factor replacement. If personnel and adequate clotting factor replacement are available, relaparotomy should not be delayed for management of intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy.
Figures and Tables
Table 3
Summary of 10 cases of relaparotomy
relapa: relaparotomy, P-RBC: packed red blood cells, WB: whole blood, FFP: fresh frozen plasma, Cryo: cryoprecipitate, PC: platelet concentrate, HD: hospital days, Prev: previous, C/S: cesarean section, Preg: pregnancy, wk: weeks, Br: breech, DM: diabetes mellitis, Pl: placenta, seg: segment, Ut: uterine, R-C/S: repeat cesarean sectiom, C-TAH: cesarean total abdominal hysterectomy, ROS: right salpingo-oophorectomy, vag. del: vaginal delivery, TAH: total abdominal hysterectomy after vagianl delivery, V/S: vital sign, Vx: vertex, Lt: left, lig: ligament, FTP: Failure to progress, int. iliac a. embol: internal iliac artery embolication, post: posterior, ER: emergency room, op: operation, BP: blood pressure, CPR: cardiopulmonary resuscitation, GI: gastrointestianl.
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