Author(s): Ryszard Por?ba
Postpartum hemorrhage remains a common obstetrical condition and the most frequent cause of perinatal maternal mortality in Poland. A protocol of management of postpartum hemorrhage has been proposed, which is based on both local and foreign publications and founded on the advancements in the field issued by Bukowski (Maternal Fetal Medicine) and Hankins (Department of Obstetrics & Gynaecology, University of Texas). The protocol has been modified and adjusted to meet the needs of Polish clinical practice. The author has drawn on the research he has conducted and the methods of treatment he has developed. The protocol has been formulated with regard to the “step by step” procedures undertaken by the whole team in the delivery suite in case of a postpartum hemorrhage. The scheme states how to identify rapidly the cause of hemorrhage, what measures to take and in what order. It shows how to stop or reduce blood loss in a quick way and prevent oligovolemic shock. The application of surgical treatment has been discussed as a means of management after the failure of pharmacological and non-surgical methods. The protocol also comprises surgical treatment, differentiated into procedures of the I and II degree. The surgical treatment of the first degree includes ligation uterine arteries from the side adjacent to the vaginal fornices by means of Kervin – Chrobak’s or Hebisch – Huch’s sutures. If ineffective, it is followed by the surgical treatment of the second degree involving laparotomy, placing B – Lynch’s sutures (in uterine atony), underpinning of uterine arteries (after O’Leary) as well as obliteration of ovarian-uterine anastomosis. Uterine extraction should be carried out only after unsuccessful application of the above-mentioned methods.