Intraoperative Hemostasis in Case of Placenta Abruption — the Right of Choice
https://doi.org/10.31550/1727-2378-2024-23-5-37-42
Abstract
Aim. To evaluate the effectiveness of various variants of hemostatic sutures in the fight against obstetric bleeding caused by premature rupture of placenta and prevention of massive blood loss.
Design. Analytical review and cohort retrospective study.
Materials and methods. The analysis of the effectiveness of intraoperative hemostasis methods was carried out on the basis of data from 24 domestic and foreign scientific publications devoted to the problem of PPRP over the past 10 years (2014–2024). The information obtained was compared with the results of using a local algorithm for intraoperative hemostasis in 182 women with bleeding that occurred in the Clinical Maternity Hospital No. 2 in Volgograd in 2010–2023. The main group included 138 (75.8%) patients who underwent uterine devascularization on both sides at two levels. The comparison group consisted of 44 women who used B-Linch compression sutures: in 37 (20.3%) cases, only compression sutures were applied, in 7 (3.9%) a combination of these methods was used.
Results. According to the literature, placenta abruption is the most common cause of bleeding that required surgical hemostasis. Uterine devascularization allowed the organ to be preserved in 135 out of 138 patients, while with the use of compression sutures and their combination with devascularization, the uterus was preserved in 37 out of 44 operated maternity hospitals (OR — 8.514; 95% CI: 2.098–34.544), which confirms the statistically significant effectiveness of devascularization.
Conclusion. It is advisable to start intraoperative stop of uterine bleeding caused by placenta abruption with uterine devascularization. This relatively easy-to-perform method of hemostasis in uterine bleeding may be the method of choice in maternity hospitals of the 1st and 2nd groups.
About the Authors
N. A. Zharkin
Volgograd State Medical University
Russian Federation
Russian Federation
1 Pavshikh Bortsov Sq., Volgograd, 400066
N. A. Burova
Volgograd State Medical University
Russian Federation
Russian Federation
1 Pavshikh Bortsov Sq., Volgograd, 400066
A. E. Miroshnikov
Volgograd State Medical University
Russian Federation
Russian Federation
1 Pavshikh Bortsov Sq., Volgograd, 400066
Yu. A. Shatilova
Volgograd State Medical University
Russian Federation
Russian Federation
1 Pavshikh Bortsov Sq., Volgograd, 400066
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Review
For citations:
Zharkin N.A., Burova N.A., Miroshnikov A.E., Shatilova Yu.A. Intraoperative Hemostasis in Case of Placenta Abruption — the Right of Choice. Title. 2024;23(5):37-42. (In Russ.) https://doi.org/10.31550/1727-2378-2024-23-5-37-42
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