[Stepwise uterine devascularization in postpartum hemorrhages]

The authors reported the results from a retrospective investigation of 10121 deliveries for a three-year period (1981-1983) as well as from a prospective study of 6239 child-births during a three-year period after a 20-year-long time lag, i.e., in 2000-2002. The cases with early post-partum hemorrhages (EPH) and with accomplished laparotomy were examined. The causes for EPH, the obstetric therapeutic measures and manipulations prior to the laparotomy as well as the surgical interventions after opening the abdomen were considered. The authors emphasized that 20 years ago three uteri only could be "saved" by means of ligation of the uterine vessels. A hysterectomy was carried out in 21 cases with massive EPH after the laparotomy. After two decades the situation changed dramatically. The hysterectomies amounted to only 22.22% of the cases (n = 4) while in the rest females (n = 14) the copying of the massive hemorrhages was performed by means either of stepwise ligation of the uterine vessels, or of ligation of the hypogastric ones in 3 cases with additional vaginal lacerations. It was outlined that mother's mortality rate was zero during these two periods. The conclusion has been drawn that the ligation of the uterine vessels represents an alternative to the hysterectomy when copying the EPH and preserves the child-bearing functions of some females because of the subsequent vascular recanalization.