1/14. A hypothesis to explain the occurence of inner myometrial laceration causing massive postpartum hemorrhage.BACKGROUND: Inner myometrial lacerations were found in three patients who developed uncontrollable postpartum massive bleeding despite the usual treatment for uterine atony. Because all the patients suffered from hemorrhage shock and their medical status deteriorated, their uteri were surgically removed to stop bleeding. After removal, one of them died. postpartum hemorrhage was caused by inner myometrial laceration. We hypothesized a cause of inner myometrial laceration, using the three resected uteri, an assumed model of the uterine body, and 34 women. methods: The subjects were 37 women, of whom three were patients with inner myometrial laceration, 23 were women without inner myometrial laceration who underwent cesarean section, and 11 were women in the first stage of labor. The three resected uteri were examined both macroscopically and microscopically. We measured the thickness of the wall of the uterine muscle at the widest point of the uterine corpus and the thickness of the myometrial wall at a transverse section of the uterine cervix, as well as the radius of the inner lumen at the widest point of the uterus in 23 women during cesarean section. We also measured the thickness of the myometrial wall at the widest point of the uterine corpus in 11 women at the end of the first stage of labor during ultrasonic examination. The data were then used to estimate the stress on the uterine muscle. RESULTS: The stress on the uterine cervix was stronger than that on the uterine corpus during labor. When the stress on the uterine muscle is stronger than a specific value, inner myometrial lacerations develop on the right and/or left side of the uterine cervix. These lacerations may involve large vessels. CONCLUSIONS: We have discovered another cause of postpartum hemorrhage which we have named inner myometrial laceration. These lacerations appeared to result from a strong stress on the uterine cervix caused by an abnormal rise in intrauterine pressure during labor.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/14. Laparoscopic bipolar coagulation of uterine vessels to manage delayed postpartum hemorrhage.postpartum hemorrhage (PPH) is a big challenge for obstetricians. fertility-preserving procedures are encouraged, especially in young women. Bilateral hypogastric (internal iliac) artery ligation, bilateral uterine artery ligation after vaginal delivery or after cesarean delivery, and uterine artery embolization are well documented vascular occlusive methods for treating PPH. To our knowledge, the laparoscopic approach to uterine artery ligation has not been reported. A 29-year-old woman experienced delayed PPH. Although curettage of the uterine cavity to remove retained placenta was performed, bleeding did not stop. We successfully performed a relatively new method--laparoscopic bipolar coagulation of uterine vessels--to stop bleeding and preserve the uterus.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
3/14. Arteriovenous malformation of the uterus associated with secondary postpartum hemorrhage.We present the case of a young woman with persistent secondary postpartum hemorrhage. Transvaginal imaging demonstrated an irregular pulsatile lesion in the anterior myometrium. color Doppler analysis revealed the presence of abnormal vessels consistent with an arteriovenous malformation. Typically this vascular abnormality had a turbulent pattern of arterial and venous flow with high peak velocities and low resistance. The patient was treated with selective arterial embolization leading to a full recovery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/14. Spontaneous rupture of ovarian artery aneurysm in the puerperium. Two case reports and a review of the literature.A case of spontaneous puerperal rupture of an aneurysm of a branch of the right ovarian artery is reported and the histological and histochemical changes in the vessel wall are described. Identical changes were also seen in a similar case, previously reported. Some of the factors involved in the pathogenesis of these unusual vascular lesions are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/14. The B-Lynch technique for postpartum haemorrhage: an option for every gynaecologist.Postpartum haemorrhage may be a life threatening complication. Seven cases are described in which the B-Lynch surgical technique (a brace like suture over the uterus) was successful in obtaining haemostasis. In four cases, the B-Lynch technique was the first line of treatment. In three cases, the B-Lynch was used after, or in combination with artery or other vessel ligation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/14. Successful embolization of an ovarian artery pseudoaneurysm complicating obstetric hysterectomy.Transcatheter arterial embolization is becoming the therapy of choice for controlling obstetric hemorrhage, affording the ability to control persistent bleeding from pelvic vessels while avoiding the morbidity of surgical exploration. The clinicians are left with little choice if pelvic hemorrhage continues after hysterectomy and ligation of anterior division of both internal iliac arteries. We present one such case of intractable post-obstetric hysterectomy hemorrhage in which an ovarian artery pseudoaneurysm was diagnosed angiographically and successfully embolized, highlighting the role of transcatheter embolization.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/14. Inner myometrial laceration causing a massive postpartum hemorrhage: a case report.BACKGROUND: postpartum hemorrhage has many well-established etiologies. It may also be secondary to an inner myometrial laceration, a less frequent and more difficult entity to diagnose. CASE: A 31-year-old, white woman, gravida 4, para 2012, at term underwent an uncomplicated spontaneous vaginal delivery. She gave birth to a 3,600-g female infant. An immediate massive postpartum hemorrhage ensued, unresponsive to medical therapy. No cervicovaginal lacerations or retained placental tissue was found. Uterine packing failed to control the bleeding. During laparotomy, exploration of the uterine cavity revealed a 4-cm, posterior and longitudinal inner myometrial laceration involving an actively bleeding large vessel. Repairing the laceration controlled the hemorrhage. CONCLUSION: Inner myometrial lacerations must be considered in the differential diagnosis of postpartum hemorrhage when all other commonly established causes have been excluded. During laparotomy and hysterotomy, evaluation and repair of an inner myometrial laceration controls the bleeding and avoids a hysterectomy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/14. Retzius' space haematoma after spontaneous delivery: a case report.We report a case of a haematoma of the Retzius space after spontaneous uncomplicated delivery. In the postpartum period, the patient complained of urinary retention and pain in the hypogastric region radiating to her left hip and leg. The ultrasound examination showed the presence of 160 x 100 x 80 mm confluent solid and liquid areas with peripheral vascularization. At exploratory laparotomy a haemorrhagic infiltration was found in Retzius' space and the anterior wall of the bladder, which appeared thickened and swollen below the peritoneum. We tried to drain the haematoma, however, we failed to drain it completely because of the large blood infiltration in the bladder wall. Clinical and ultrasound follow-up examinations showed a progressive reduction of the haematoma which completely disappeared nine months later. The haemodynamic changes occurring during pregnancy and labour, associated with strong mechanical stress, seem to be among the major causative factors of haematoma formation. Moreover, the venous load in the pelvic vascular system is increased during pregnancy; a stress-induced increase in venous blood pressure might play a prominent role, especially in cases of venous ectasia, where the resistance of blood vessel walls is reduced. Intraoperative evidence seemed to suggest a haemorrhage secondary to the rupture of the venous vessels in the Santorini plexus. The rupture was probably caused by the thrust of the fetal head, associated with abnormality or fragility of the blood vessels, or by some pathologic changes occurring in the anatomical structures during pregnancy, which could not be accurately defined because of the severity and degree of the haematoma infiltration found intraoperatively.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
9/14. Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization.A case of severe postpartum hemorrhage is reported. Three separate surgical procedures failed to reveal the source of bleeding, and standard surgical techniques, including bilateral ligation of the hypogastric arteries, were unsuccessful in producing hemostasis. However, angiography successfully identified the specific bleeding vessel, and transcatheter embolization with Gelfoam fragments quickly and effectively stopped the hemorrhage. The authors consider angiographic embolization to be an effective alternative approach to the control of pelvic hemorrhage and recommend that the technique be considered prior to surgical intervention.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/14. ehlers-danlos syndrome and pregnancy.ehlers-danlos syndrome is a genetically transmitted disorder of connective tissue characterized by hyperelasticity of the skin, hyperflexibility and looseness of the joints, easy bruisability of the skin, and in the more severe forms of the disease, arterial fragility and tendency to rupture. Pregnant patients with ehlers-danlos syndrome are at increased risk for various complications, most serious of which is rupture of a major vessel. The present case report is the second known report of a maternal death from rupture of a major artery in a patient with the severe type IV variant of the syndrome. The advisability of pregnancy and genetic counseling are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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