Hemorrhage;Postpartum Period; Uterine Inertia; prevention & control; 777 postpartum women were studied at Tu Du Obstetric and Gynecology Hospital, HCM city. Rectal misoprostol of 400mg was well tolerated and effective to reduce hemorrhage amount and to shorten the 3rd phase of labor just after the delivery. The procedure is simple with low cost, easy to use in remote areas of the country contributing in lowering obstetric accidents and mortality.
Hemorrhage ; Postpartum Period ; Uterine Inertia ; prevention & control

We report a case of unrecognized uterine inversion was restored spontaneously without surgical intervention. Initially, the case was diagnosed as uterine atony and not uterine inversion and was managed successfully with uterine artery embolization. However, a partial uterine inversion was detected on a subsequent scheduled pelvic examination. Fortunately, her uterus was completely restored without any surgical intervention on eighth week after delivery.
Gynecological Examination ; Postpartum Hemorrhage ; Uterine Artery Embolization ; Uterine Inertia ; Uterine Inversion* ; Uterus

The objective is to evaluate the rate and indications of cesarean delivery. All live birth>27weeks at the Dongsan Medical Center, Keimyung University from 1993 to 1997(n=24,227) were respectively analyzed of delivery route, indication of cesarean birth, gestational age, and matemal age. The most common maternal age was between 26-30 years(49.6%). The most common gestational age was over 36 weeks(91.2%). Total cesarean rate was 22.3%(5,396/24,227), and primary rate was 13.6%(3,296/24,227). The annual primary cesarean birth rate and number increased gradually. Abnormal presentation was the most common indication(24.3%, 801/3,296) at primary cesarean deliveries. The second common indication was CPD(18.87%, 622/3,296). We experienced four cases of cesarean hysterectomy due to uterine atony and placenta previa. Further evaluation will be needed about the relationship between cesarean deliveries and long term fetal outcome, and the effort for VBAC will be needed.
Birth Rate ; Gestational Age ; Hysterectomy ; Maternal Age ; Parturition ; Placenta Previa ; Uterine Inertia

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

The management of postpartum hemorrhage remains one of the significant challenges to clinical practitioners of obstetrics. Massive postpartum hemorrhage is a major cause of maternal death and morbidity. Early postpartum hemorrhage refers to bleeding within the first 24 hours after delivery; late of delayed postpartum hemorrhage occurs more than 24 hours but less than six weeks after delivery. Uterine atony remains the most common cause with many patients presenting with no known risk factors. Postpartum bleeding can result from uterine atony, genital tract lacerations or hematomas, retained placenta, uterine inversion and acquired or inherited coagulopathies. Every obstetrics unit should have protocols available to deal with hemorrhage and have specific guidelines for patients who object to blood transfusions for various reasons. Placement and utilization of arterial catheters for uterine artery embolization is becoming more widespread. Timely hysterectomy should be performed for signs of refractory bleeding. Application of medical and surgical principles combined with recent new technologic advances will help the obstetrician avoid disastrous outcomes for both mother and fetus.
Blood Transfusion ; Catheters ; Fetus ; Hematoma ; Hemorrhage ; Humans ; Hysterectomy ; Lacerations ; Maternal Death ; Mothers ; Obstetrics ; Placenta, Retained ; Postpartum Hemorrhage* ; Postpartum Period* ; Risk Factors ; Uterine Artery Embolization ; Uterine Inertia ; Uterine Inversion

A 30-year-old female underwent emergency cesarean section with general anesthesia. In the past history, she has no specific problem. After delivery of fetus and placenta, there was continuous uterine bleeding due to uterine atony. Surgeon injected 1 mg of sulprostone (prostaglandin E2) into the uterine muscle and 1 mg of sulprostone was injected intravenously. One hour after sulprostone injection, high fever was detected. Sulprostone has been known to have side effects such as nausea, vomiting, uterine rupture, pulmonary edema and fever. Therefore, when we inject sulprostone into the uterine atonic bleeding patient, it is necessary to pay attention to fever for it's complication, in giving overdose.
Adult ; Anesthesia, General ; Anesthesia, Obstetrical ; Animals ; Cesarean Section* ; Emergencies ; Female ; Fetus ; Fever* ; Hemorrhage ; Humans ; Mice ; Myometrium ; Nausea ; Placenta ; Pregnancy ; Pulmonary Edema ; Uterine Hemorrhage ; Uterine Inertia ; Uterine Rupture ; Vomiting

OBJECTIVE: To compare the clinical characteristics and outcome of hysterectomy and angiographic embolization in the management of obstetrical hemorrhage unresponsive to conservative management. METHODS: We retrospectively analyzed 88 patients who underwent hysterectomy and 53 patients who underwent angiographic embolization for the management of obstetrical hemorrhage from January 1999 to July 2007. We analyzed the maternal characteristics and outcomes by the review of medical records and telephone interview. Nonparametric test was performed for comparison of both groups. RESULTS: Angiographic embolization for the management of obstetrical hemorrhage is on the increase year by year, consisting of about three quarters of total cases in the last year. The most common indication of hysterectomy was abnormal placentation (68.2%) followed by uterine atony (25.0%). For the embolization, the most common indication was uterine atony (54.7%) followed by abnormal placentation (17%). The median pre-operative hemoglobin was significantly lower in embolization group than hysterectomy group [8.3 (3.8~12.7 g/dL) vs. 10.8 (2.4~13.7 g/dL), P<0.001]. There was no difference in the total transfusion amount of packed RBC between the two groups. The median hospital stay was shorter in embolization group [8 (5~57 days) vs. 6 (3~14 days), P<0.001]. Overall success rate of embolization was 89% and procedure-related acute complications were not occurred. Of the total population, there was one maternal death in the hysterectomy group. We found that most women who underwent the embolization resume normal menstruation. CONCLUSION: Angiographic embolization for the management of obstetrical hemorrhage is more commonly performed in recent years. Angiographic embolization was associated with shorter hospital stay, reasonable success rate, and minimal complication rate.
Female ; Hemoglobins ; Hemorrhage ; Humans ; Hysterectomy ; Interviews as Topic ; Length of Stay ; Maternal Death ; Medical Records ; Placentation ; Postpartum Hemorrhage ; Retrospective Studies ; Uterine Inertia

Vesicovaginal fistula may be a complication of gynecologic and obstetric procedures, of which abdominal hysterectomy remains as the most common cause. Although there are a number of transvaginal or transabdominal surgical techniques for the correction of this condition, we performed a laparoscopic repair to reduce the morbidity of the transabdominal approach. A 44-year-old woman presented with urinary incontinence after undergoing Cesarean hysterectomy for uterine atony eight years ago. After confirming her vesicovaginal fistula, laparoscopic repair was performed. The bladder and vaginal walls were mobilized by meticulous dissection and repaired by intracorporeal stitches in 2 layers followed by omental interposition. Total operative time was 3 and half hours and estimated blood loss was about 400 ml. Foley catheter was removed at 23rd day after operation. Patient was discharged at 26th day after confirming the complete correction of the fistula by cystogram. Laparoscopic repair of a vesicovaginal fistula appears to be a safe and effective procedure. We report this case with a brief review of literature.
Adult ; Catheters ; Female ; Fistula ; Humans ; Hysterectomy ; Laparoscopy ; Operative Time ; Urinary Bladder ; Urinary Incontinence ; Uterine Inertia ; Vesicovaginal Fistula

OBJECTIVE: To evaluate the clinical indications and incidence of emergency peripartum hysterectomy by dermographic characteristics by a retrospective review based on hospital data of 98 patients over 8 years. METHODS: We reviewed their medical records of the 98 cases of peripartum hysterectomy among 50,338 deliveries, from January. 1992 to December. 1999, at St Mary, Kang Nam St Mary, and Holy Family hospital of Catholic University. RESULTS: The total incidence of peripartum hysterectomy was 98/50,338 (0.19%), Cesarean hysterectomy was performed in 96 of 22,561 Cesarean sections (0.43%) and in 2 of 27,777 vaginal deliveries (0.01%). The higher the age, the higher incidence of peripartum hysterectomy was noted and the most common indication for hysterectomy was abnormal adherent placentation (45.48%) followed by uterine atony (39.80%). During peripartum hysterectomy, patients were transfused with mean 10.04 pints. Although one maternal death occurred, maternal morbidity remained high (51.02%), including postoperative febrile condition in 15 (15.3%), intraoperative urologic injury in 11 patients (11.2%). CONCLUSION: There is a strong association between advancing age and incidence of peripartum hysterectomy. The data identify abnormal adherent placentation as the primary cause for peripartum hysterectomy and then considering the mean volume of blood loss more than 10 pints of blood should be prepared before emergency hysterectomy.
Cesarean Section ; Emergencies* ; Female ; Humans ; Hysterectomy* ; Incidence ; Maternal Death ; Medical Records ; Peripartum Period* ; Placentation ; Pregnancy ; Retrospective Studies ; Uterine Inertia

OBJECTIVE: To access the pregnancy tendency and delivery in women aged 40 years and older. METHODS: From January 1999 to June 2001, 7882 deliveries were in Gacheon Medical School. Among them we compared 95 cases of pregnant women aged 40 years and older with 94 cases of those aged under 40 years as a control group. RESULTS: The parity was higher in women aged older than 40 years compared to control group. Number of prenatal special studies was higher in women aged older than 40 years (n=82) compared to control group (n=14). In modes of delivery and indications for c/sec, there were no difference in two groups. There were no difference in prenatal complications between two groups. But, number of cases related to placenta previa, myoma and anemia were increased in women aged older than 40 years. In postpartum complications, uterine atony and hysterectomy, postpartum bleeding and placenta accreta were higher in women aged older than 40 years compared to control group. CONCLUSION: For pregnant women aged 40 years and older, a careful approach and appropriate management will be necessary for good pregnant outcome.
Anemia ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Myoma ; Parity ; Placenta Accreta ; Placenta Previa ; Postpartum Period ; Pregnancy* ; Pregnant Women ; Schools, Medical ; Uterine Inertia