Postpartum hemorrhage (PPH) is a life-threatening condition and remains a leading cause of maternal mortality. Transcatheter arterial embolization (TAE) is an effective therapeutic strategy for PPH with the advantages of fast speed, repeatability, and the possibility of fertility preservation. We reviewed the vascular anatomy relevant to PPH, the practical details of TAE emphasizing the timing of embolization, and various clinical conditions of PPH according to a recent literature review.
Fertility Preservation ; Maternal Mortality ; Postpartum Hemorrhage* ; Postpartum Period*

Traditionally postpartum hemorrhage is a bleeding more than 500 ml that occurs immediately after the placenta is delivered. It remains one of the most common causes of maternal mortality. Morbid adhesion of the placenta is emerging as a major cause of massive postpartum hemorrhage unresponsive to medical therapy. We experienced three cases of major postpartum hemorrhage over 5,000 ml, developed from anterior placenta previa totalis with adhesion of placenta. The hemorrhage had been controlled successfully by compressing abdominal aorta intermittently with the operator's hand during Cesarean hysterectomy. In immediate life- threatening postpartum hemorrhage this simple and safe technique can be used in slowing the bleeding while stabilizing the patient and preparing for definitive treatment.
Aorta, Abdominal ; Hand ; Hemorrhage ; Humans ; Hysterectomy ; Maternal Mortality ; Placenta ; Placenta Previa ; Postpartum Hemorrhage* ; Postpartum Period*

OBJECTIVE: Postpartum hemorrhage is most common cause of maternal mortality. Active management of third stage of labor minimizes the risk of postpartum hemorrhage. To compare the effect of methylergonovine and 15-methyl prostaglandin F2alpha (15-methyl PGF2alpha) in active management of third stage of labor. METHODS: A randomized open labelled parallel study with 50 women in normal labor, 25 in each group were included. The drugs methylergonovine (0.2 mg) intravenous and 15-methyl PGF2alpha (250 microg) intramuscular were administered at the time of delivery of anterior shoulder. Main outcomes measured were amount of blood loss during the first four hours of delivery and objective measurement of hemoglobin and hematocrit levels before delivery and third day postpartum. RESULTS: There was no statistically significant difference in the blood loss between the two groups at delivery (P = 0.130), at 1 hour of delivery (P = 0.453). The blood loss with 15-methyl PGF2alpha was significantly less as compared to that of blood loss with methylergonovine at four hours of delivery (P = 0.014) and the total, i.e., during first four hours, amount of blood loss was significantly less with 15-methyl PGF2alpha (P = 0.026). There was no statistically significant difference in the hemoglobin and hematocrit levels measured predelivery and postpartum third day between both the drugs. CONCLUSION: Both the drugs were effective in controlling the amount of blood loss during the third stage of labor, 15-methyl PGF2alpha being more efficacious.
Dinoprost ; Female ; Hematocrit ; Hemoglobins ; Humans ; Maternal Mortality ; Methylergonovine ; Postpartum Hemorrhage ; Postpartum Period ; Shoulder

Postpartum hemorrhage is an important cause of maternal mortality and morbidity. Especially uterine atony is the most common cause of postpartum hemorrhage. Conventional method to control postpartum uterine atonic bleeding is based on the use of oxytocin and ergot preparations. Prostaglandin F2alpha analogue such as carboprost can be used to promote contraction when these agents fail to produce uterine contraction. Prostaglandin E1 analogue, misoprostol has uterotonic effect by oral or vaginal administration. They are used to induce labor and first or mid trimester abortion. In postpartum uterine atonic bleeding, misoprostols cannot be used via oral or vaginal route. Recently we have experienced that postpartum uterine atonic bleedings unresponsive to conventional methods were controlled by rectal misoprostols. So we report these cases with a brief review of literatures.
Administration, Intravaginal ; Alprostadil ; Carboprost ; Dinoprost ; Hemorrhage* ; Maternal Mortality ; Misoprostol* ; Oxytocin ; Postpartum Hemorrhage ; Postpartum Period* ; Uterine Contraction ; Uterine Inertia

Retroperitoneal hemorrhage caused by intra-abdominal vascular injury during pregnancy or puerperium is rare, but a very fatal complication. Massive retroperitoneal hemorrhage causes the high mortality rate of mother and fetus. But the difficulty of diagnosis and rarity may delay prompt treatment. We experienced a case of massive retroperitoneal hemorrhage, which was caused by a suspected left lumbar artery aneurysm rupture on the fifth day of vaginal delivery. The patient was successfully treated by surgery and arterial embolization. We reported this case with a brief review of literature.
Aneurysm* ; Arteries* ; Diagnosis ; Fetus ; Hemorrhage ; Humans ; Mortality ; Mothers ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy ; Rupture ; Rupture, Spontaneous* ; Vascular System Injuries

OBJECTIVE: To examine the changes of maternal mortality ratio and the causes of death in Korea during 1995-2000. METHODS: Maternal mortality data were collected through two stages: collection of registration data and maternal mortality survey at medical institutions. The cause of death was judged by agreement of three obstetrician. RESULTS: Maternal mortality ratio decreased from 20 (per 100,000 live births) in 1995 to 18 in 1999 and 15 in 2000. The mortality ratio was higher for women 35 years and older. Postpartum hemorrhage, hypertensive disorders of pregnancy, and obstetric embolism are three main causes of maternal death which comprised about half of all maternal death. CONCLUSION: Maternal mortality ratio decreased during 1995-2000. All causes of maternal death decreased since 1995. However obstetric embolism appeared to be relatively more important cause of death in 1999-2000.
Cause of Death* ; Embolism ; Female ; Humans ; Korea* ; Maternal Death ; Maternal Mortality* ; Mortality ; Postpartum Hemorrhage ; Pregnancy

Adult ; Cause of Death ; China ; epidemiology ; Embolism, Amniotic Fluid ; mortality ; Female ; Humans ; Maternal Mortality ; Postpartum Hemorrhage ; mortality ; Pre-Eclampsia ; mortality ; Pregnancy

*Eclampsia ; *Infusions, Parenteral ; *Ireland ; *Maternal Mortality ; *Postpartum Hemorrhage ; *Puerperal Infection ; *Shock, Hemorrhagic ; *Pregnancy

Pregnancy and the puerperium are associated with an increased risk of stroke, and stroke is considered an important cause of maternal morbidity and mortality during this time. Pregnancy and delivery can lead to substantial alterations in systemic arterial and venous hemodynamics that may predispose to cerebrovascular disorders. We present one case of cerebral hemorrhage in puerperium after a normal pregnancy without any manifestation of preeclampsia or eclampsia and the other case with recurred cerebral hemorrhage in 16 gestational weeks pregnancy with previous cerebral hemorrhage history.
Cerebral Hemorrhage* ; Cerebrovascular Disorders ; Eclampsia ; Female ; Hemodynamics ; Mortality ; Postpartum Period* ; Pre-Eclampsia ; Pregnancy ; Stroke

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest* ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced* ; Hysterectomy* ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Resuscitation