Chapters authored
Hemostasis for Massive Hemorrhage during Cesarean Section
Arterial ligation for massive hemorrhage during cesarean section may often fail to achieve hemostasis because of abundant collateral circulation. In recent years, various methods of hemostasis have been used, of which the most common are compression sutures, uterine balloon tamponade. In cases of massive hemorrhage, patients must be kept in good systemic condition, and local hemostasis must be achieved while paying attention to the possible occurrence of coagulopathy under monitoring of fibrinogen levels. When concomitant coagulopathy is present, local hemostasis is difficult to achieve because of hemorrhagic tendency. In such a case, obstetrical damage control procedures should be performed. First, the hemorrhagic area should be compressed with a towel or balloon, and at the same time, the artery should be blocked or compressed to reduce the blood flow into the uterus. The following resuscitation must also be implemented for warming intervention; blood transfusion to maintain the circulating blood volume; and the treatment of coagulopathy by “triple C supplement,” such as combined administration of fresh-frozen plasma and concentrated coagulation factors promptly to obtain a blood fibrinogen level of at least 150–200 mg/dL. If coagulopathy is eliminated, the conventional hemostatic procedures become effective. Hysterectomy is the last measure for hemostasis.
Part of the book: Recent Advances in Cesarean Delivery