Post Partum Hemorrhage | PPH Management |

Описание: Surgical management of postpartum hemorrhage (PPH) involves uterine-sparing techniques like compression sutures (B-Lynch, Hayman, Cho) and pelvic vessel ligation (uterine, internal iliac arteries) to preserve fertility, often used when medical treatments fail. If bleeding continues, more invasive options include intrauterine balloon tamponade, uterine artery embolization, or ultimately, hysterectomy, the removal of the uterus, as a last resort to control life-threatening hemorrhage.

Uterine-Sparing Techniques (Conservative Surgery)
Compression Sutures: These aim to mechanically compress bleeding vessels within the uterine wall.
B-Lynch Suture: Loops absorbable sutures from the lower to upper uterus for external compression.
Hayman Suture: A vertical mattress suture across the fundus.
Cho Suture: Square stitches approximating anterior and posterior uterine walls to close bleeding sinuses.
Pelvic/Uterine Artery Ligation: Ligation of the uterine arteries or the anterior division of the internal iliac artery to reduce blood supply to the uterus.
Uterine Artery Embolization (UAE): Blocking uterine arteries with embolic material (like Gelfoam) to stop bleeding while preserving the uterus.

Balloon Tamponade & Other Methods
Uterine Balloon Tamponade: Inserting a balloon (e.g., Bakri, Ebb) into the uterus and inflating it to compress the bleeding site.
Suturing Placental Bed: Applying sutures directly to the bleeding placental site, especially for placenta previa.

Non-Conservative Management
Peripartum Hysterectomy: Surgical removal of the uterus, performed when all other measures fail to control bleeding and the patient's life is at risk, often due to unrepairable rupture or severe atony.

General Approach
Management starts with addressing underlying causes (like retained placenta or tears) and uterotonics, with surgical options escalating if bleeding persists, prioritizing uterine preservation where possible before resorting to hysterectomy.

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