Sunday, 17 March 2019

How best to control PPH(postpartum hemorrhage at Cesarean delivery)?? Possible options?


Uterine atony after closure of uterus: to react or to ignore the atony at Theatre?? If we cross a busy road and see a car is coming very fast what we do we don’t take risk. Instead we wait till the high speed car crosses my way. Then and then only we cross the busy road. Uterine atony after closure of uterus is not an uncommon finding or should I say a nuisance. How best to deal with such a situation even if O T Sister affirms that there is no active bleeding PV. There are several options: Option A) No active addle step taken-just close as sister has assured U abd U have patiently waited for 5 minutes before U closed the abdomen. Option B) I V or I M methergin (methyl ergometrine) Option 3:-Intra myometrial prostaglandins Option 4:-To put Prof B Lynch Compression suture.-may be one or two. Whether to put B Lynch suture by Char catgut No 1(viral will cut through) or not?? .I had the misfortune to perform about 500 Obstet hysterectomies during my active life say 1966 to 2015 for variety reasons. For details Pl see my blog See my Blog “(PROF.) DR. SRIMANTA KUMAR PAL (SENIOR GYNECOLOGIST).” I had the misfortune of carrying out about 500 Obstet Hits. (1966-2015. .In fact I am a great fan of putting B Lynch compression stitches and due to my forwardness I don’t like my patient back from ward/recovery Room to Theater again for contd PPH due to atony and pack the uterine cavity or put Balloon. Your opinion please.

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