Obstetric Management of Postpartum Haemorrhage
Obstetric haemorrhage remains the leading cause of maternal mortality and morbidity worldwide, but deaths are rare in developed countries. The use of interventional radiology over the last 30 years has changed from a novel technique in specialised centres
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Contents
Abstract
1
Introduction.......................................................................... 181
2
Physiological Changes in Pregnancy................................. 182
3
Postpartum Haemorrhage .................................................. 182
4 4.1 4.2 4.3
Management of Postpartum Haemorrhage...................... Tamponade Techniques......................................................... Uterine Compression Sutures................................................ Internal Iliac Artery Ligation................................................
5
Role of Interventional Radiology in Postpartum Haemorrhage........................................................................ 185
Obstetric haemorrhage remains the leading cause of maternal mortality and morbidity worldwide, but deaths are rare in developed countries. The use of interventional radiology over the last 30 years has changed from a novel technique in specialised centres to become a viable management option in the control of massive haemorrhage both before and after hysterectomy. This chapter covers the management of postpartum haemorrhage and the role of interventional radiology.
183 183 183 184
References...................................................................................... 187
1
M. Nwandison (&) Speciality Registrar in Obstetrics and Gynaecology, London Deanery, London, UK e-mail: [email protected] S. Bewley Academic Women’s Health Centre, King’s College London, 10th floor North Wing, St Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
Introduction
Worldwide it has been estimated that 358,000 maternal deaths occurred in 2008 (WHO, UNICEF, UNFPA and The World Bank publication 2012, http://whqlibdoc. who.int/publications/2010/9789241500265_eng.pdf; http:// www.childinfo.org/maternal_mortality.html), with developing countries accounting for 99 % of cases. Haemorrhage remains the leading cause of maternal mortality, accounting for approximately one-third of deaths. The presence of skilled birth personnel with appropriate training and skills has continued to be identified as key to preventing and reducing maternal deaths worldwide. Haemorrhage itself is common in both the developed and developing countries, it is the success in saving lives that varies. In the United Kingdom, obstetric haemorrhage was identified as the sixth most common cause of direct maternal death in the most recent Confidential Enquiry into Maternal Deaths (CMACE 2011). In the triennium 2006–2008, 261 women in the UK died directly or indirectly related to pregnancy. Nine out of the total of 107 direct deaths (8.4 %) were attributable to haemorrhage. Six of the nine women (67 %) received substandard care in their management and four of the nine women (44 %) had received major substandard care contributing significantly
J. Reidy et al. (eds.), Radiological Interventions in Obstetrics and Gynaecology, Medical Radiology. Diagnostic Imaging, DOI: 10.1007/174_2013_852, Springer Berlin Heidelberg 2013 Published Online: 4 July
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