[Peri-partum hemorrhage: surgical management]

Surgeons must be aware of the surgical techniques necessary to control grave peri-partum hemorrhage which place the life of the mother in jeopardy; at times, surgery is the only life-saving solution in spite of all the medical, obstetrical, and interventional radiologic techniques which have been developed. Surgical indications and approaches must take into account several factors - the cause of the hemorrhage, the urgency defined by the hemodynamic status of the patient, the technical and human means available, and the obstetrical situation (vaginal versus caesarean delivery). When medical and obstetrical management along with fluid resuscitation prove inadequate, recourse to surgery is necessary. While hysterectomy and ligation of the hypogastric arteries are time-honored treatments of last recourse, newer techniques which are both simpler and less aggressive have been developed in recent years; these newer conservative techniques should be given first choice.