Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.

my ppt SURGICAL MANAGEMENT OF PPH

  • Identifiez-vous pour voir les commentaires

my ppt SURGICAL MANAGEMENT OF PPH

  1. 1. SURGICAL MANAGEMENT OF PPH B.Hemanath
  2. 2. SURGICAL ANATOMY OF UTERUS
  3. 3. It is the final method when all the other methods fail to control post partum haemorrhage It includes two steps, Devascularisation procedure •a. Ligation of uterine arteries •b. Ligation of ovarian and ut. artery anastomosis •c. Ligation of ant. div. of int. iliac artery •d. B- Lynch compression suture and multiple square sutures •e. Angiographic arterial embolisation Hysterectomy
  4. 4. 1. Devascularisation procedure : A. Ligation of ut. arteries; Ascending branch of uterine artery ligated b/n upper and lower uterine segment. No.1. chromic catgut is used.
  5. 5. If bleeding continues. B. Ligation of ovarian & uterine artery anastamosis: Done just below the ovarian ligament. Some times, temporary occlusion of ovarian vessels at infundibulopelvic ligament is done by rubber sleeved clamps.
  6. 6. Ligation of uterine artery and utero-ovarian artery
  7. 7. C. Ligation of anterior division of internal iliac artery. Done unilaterally or bilaterally. Bilateral ligation avoids hysterectomy in 50% of the cases.
  8. 8. D. B-Lynch compression sutures & multiple square sutures Developed by Christopher B-Lynch. Used to mechanically compress an atonic uterus in the face of severe PPH. Success rate is about 80% and can avoid hysterectomy.
  9. 9. B-LYNCH SUTURE
  10. 10. E. Angiographic arterial embolisation. Done to bleeding vessel under fluoroscopy. Gel foam is used as embolus. Success rate >90% & it avoids hysterectomy.
  11. 11. Continuous observation of patient in ICU/ high dependency unit. After this procedure, if bleeding is controlled,
  12. 12. 2.Hysterectomy – Final most step. Rarely indicated. Only if uterus fails to contract & bleeding continues. If mother is parous, decision is taken earlier. It may be total or subtotal depending on the case.
  13. 13. Examination per speculum, is done under good light. Identify trauma to perineum, vagina, cervix. Hemostasis achieved by appropriate catgut sutures. For traumatic PPH

×