Abstract
Traumatic PPH can occur following vaginal or caesarean delivery and is almost always due to lapses in judgment. It should be prevented by avoiding injudicious use of prostaglandins and oxytocin, avoiding inappropriate application of forceps and ventouse, avoiding prolonged trail of labor, and performing a timely caesarean section. Deep episiotomy, cervical tears, vaginal lacerations, paraurethral tears and even perineal tears can be sutured in the labor room with adequate pain relief provided the patient is cooperative and hemodynamically stable, and good visualization of the tears is possible. Otherwise, the repair has to be done in the operation theater under GA.
Patients must be taken for LSCS well in time to prevent uterine rupture, extension into the uterines, and lower segment tears. Those cases of previous LSCS where the LSCS was done in second stage of labor are poor candidates for TOLAC, and trial should be given under the greatest supervision. Bladder and ureteric injuries are likely when there are downward tears into the lower segment. Tears and extensions should be sutured separately and should never be sutured in a straight line along with the uterine incision, and elective repeat LSCS should be done in subsequent pregnancies. The decision to perform internal iliac artery ligation and obstetric hysterectomy should never be deferred till it is too late to save the patient.
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Podder, A.R., Seshadri, J.G. (2020). Traumatic Postpartum Hemorrhage: How to Avoid and How to Manage. In: Atlas of Difficult Gynecological Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-13-8173-7_10
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DOI: https://doi.org/10.1007/978-981-13-8173-7_10
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