Massive obstetric hemorrhage
-
Z. Papp
Abstract
Massive obstetric haemorrhage is a major cause of maternal death and morbidity; abruption of the placenta, placenta praevia and postpartum haemorrhage being the main causes of haemorrhages. A delay in the correction of hypovolaemia, diagnosis and treatment of defective coagulation and/or surgical control of bleeding are the avoidable factors in most maternal deaths caused by haemorrhage. The main goal is to maintain effective circulating intravascular volume by prompt and adequate replacement of blood, crystalloids or fresh-frozen plasma through more than one intravenous line (it might be necessary to pump blood under pressure) with constant monitoring of the pulse rate and the arterial blood pressure. The rapid correction of hypovolaemia with crystalloids and red cells is the first priority, followed by blood component therapy. Oxytocin and prostaglandin will correct uterine atony, and appropriate surgical intervention is required for traumatic bleeding. Ligation of the uterine arteries, ovarian arteries and hypogastric arteries will usually control uterine bleeding and arterial embolization is also effective. Hysterectomy should also be considered in severe cases. All gynecologists should be able to perform without delay the operative maneuvers which are necessary to control the bleeding, including hypogastric artery ligation, or even emergency hysterectomy.
This topic may have received little attention because it is perceived as being associated with maternal morbidity rather than mortality in developed countries; it is only recently that the extent and importance of postnatal maternal morbidity has been recognized.
Copyright © 2003 by Walter de Gruyter GmbH & Co. KG
Articles in the same Issue
- Message from the President of the WCPM
- Message from the President of the WAPM
- Antalya Consensus on Perinatal Care:The Report of the 2nd World Congress of Perinatal Medicine for Developing Countries, 1–5 October 2002, Antalya, Turkey
- Reduction in mortality needs a bit more than the science of perinatology
- Global, regional and national perinatal and neonatal mortality
- Maternal mortality in Turkey
- Maternal mortality in developing countries
- Organization of neonatal care services and its importance
- The Misgav Ladach method – a step forward in operative technique in obstetrics
- Monitoring the IUGR fetus
- Massive obstetric hemorrhage
- Breech deliveries and cesarean section
- Iron supplementation in pregnancy
- Antenatal diagnosis and prognosis of conjoined twins – a case report
- Preliminary report on a new and noninvasive method for the assessment of fetal lung maturity
- Perinatal mortality rate – hospital based study during 1998–2001 at Hacettepe University
- The effect of glucocorticoid therapy on prevention of early neonatal complications in preterm delivery
- Congress Calendar
Articles in the same Issue
- Message from the President of the WCPM
- Message from the President of the WAPM
- Antalya Consensus on Perinatal Care:The Report of the 2nd World Congress of Perinatal Medicine for Developing Countries, 1–5 October 2002, Antalya, Turkey
- Reduction in mortality needs a bit more than the science of perinatology
- Global, regional and national perinatal and neonatal mortality
- Maternal mortality in Turkey
- Maternal mortality in developing countries
- Organization of neonatal care services and its importance
- The Misgav Ladach method – a step forward in operative technique in obstetrics
- Monitoring the IUGR fetus
- Massive obstetric hemorrhage
- Breech deliveries and cesarean section
- Iron supplementation in pregnancy
- Antenatal diagnosis and prognosis of conjoined twins – a case report
- Preliminary report on a new and noninvasive method for the assessment of fetal lung maturity
- Perinatal mortality rate – hospital based study during 1998–2001 at Hacettepe University
- The effect of glucocorticoid therapy on prevention of early neonatal complications in preterm delivery
- Congress Calendar
