refractory postpartum hemorrhage surgery

Refractory postpartum hemorrhage is a vascular interventional procedure. Interventional operation is the use of ultrasound, computed tomography (CT), nuclear magnetic resonance (MRI), X-ray, laparoscopy and other modern medical imaging technology to perform targeted surgery on the organs and tissues of the lesion for diagnosis and treatment. purpose. The law has now become an indispensable part of comprehensive treatment. Due to its advantages of micro-trauma, accurate positioning, safety and effectiveness, and fewer complications, it has developed rapidly in the past 20 years. Generally divided into two major categories of vascular interventional surgery and non-vascular interventional surgery. Vascular interventional surgery was founded in 1953 by Seldinger. According to different placement positions, there are three types: subselectivity - insertion into the abdominal aorta; selective - insertion into the primary branch of the abdominal aorta; superselection - insertion into the abdominal aorta secondary or smaller Branch. The operation is small in trauma, easy to operate, and accurate in the intervention site, which makes some inoperable patients get treatment opportunities and simplifies surgery. Mainly include: angiography, vascular embolization, angioplasty, chemotherapy, drainage and biopsy. Postpartum hemorrhage is a critically ill episode of obstetrics, and most of them can be treated conservatively, but many refractory postpartum hemorrhages require hysterectomy to save the lives of patients. In recent years, interventional radiology has been applied in obstetrics and gynaecology, so that such patients retain the uterus and achieve good clinical results. Treating diseases: advanced postpartum hemorrhage Indication 1. Postpartum hemorrhage is removed by removing the cause, supplementing blood volume, drugs (such as uterine contractions, hemostatic agents, calcium, etc.), and physical therapy (such as massage the uterus) and other conservative treatments have not been successful. 2. Late bleeding after cesarean section. 3. Repeated hysterectomy after cesarean section. Surgical procedure 1. Place the catheter. 2. Disinfect the towel with the groin area as the center. 3. Percutaneous femoral artery puncture using the Selding's method. 4. In the shock patients, the Seldinger technique is used to complete the femoral artery catheterization. The shock patients can quickly inject 400-800ml whole blood and generation plasma through the vascular sheath to supplement the blood volume, pay attention to the weakening of the femoral artery pulsation, and quickly release it as the key. . 5. Insert the 4~5F catheter into the abdominal aorta bifurcation at 2~3cm, and inject 30ml into the high-pressure syringe, the pressure is 68.0136kPa (1kPa=7.5mmHg). 10ml per second for 3s in a row. 6. Synchronous pelvic artery digital subtraction angiography (DSA) was performed to identify the bleeding site. 7. DSA imaging findings are as follows: 1 uterine contraction fatigue postpartum hemorrhage DSA showed diffuse contrast agent spillover or focal contrast agent spillover in the uterine cavity. It can be seen that the uterine artery is thickened and distorted, and the uterine artery is mutated. Under normal conditions, the uterine artery is emitted from the internal iliac artery and then goes downward. After the bleeding, the direction becomes outward and upward, and the ascending branch and the arcuate artery are also thickened. 2 part of the placenta implanted postpartum hemorrhage: DSA showed that the right side of the uterine cavity was placed at the placenta where the focal contrast agent was densely stained, spilled, and irregularly shaped. 3 uterine artery vascular rupture DSA angiography showed obvious uterine artery vascular rupture in the arterial phase, which showed obvious contrast agent spillage in the uterus artery ascending branch and inferior uterus incision, and the contrast agent stayed in the venous phase. In the case of hemorrhage after subtotal uterine resection, it can be seen that the contrast agent of the uterine artery and the cervical stump overflows, causing a large area of contrast agent to aggregate. 8. Rapidly insert the catheter into the hemorrhagic lateral iliac artery anterior trunk, according to the patient's specific circumstances, internal iliac artery embolization (IIAE) or uterine arterial embolization (UAE). 9. After injecting an antibiotic (such as ceftazidime 2.0 g), the bleeding artery was embolized with gelatin sponge particles having a diameter of 1 to 3 mm. 10. After DSA angiography confirmed that one side of the embolization was successful, the same method embolized the corresponding side of the blood vessel. 11. The catheter was removed, and the partial pressure was applied. The patient was placed in a supine position for 24 hours, and the puncture site was pressurized with a sandbag for 6 hours to prevent hematoma.