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Critical Care Obstetrics part 34

Critical Care Obstetrics part 34 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Etiology and Management of Hemorrhage average blood loss of 1435 mL when hysterectomy was performed at the time of elective repeat cesarean section 48 . At emergency hysterectomy for postpartum bleeding mean blood loss attributed to the procedure was 2183 mL with a mean loss of 2125 mL by the time of decision for hysterectomy 131 . Adequate hemostasis is not always achieved and further procedures may be necessary. Uterine artery embolization has been performed for ongoing bleeding following hysterectomy both with and without success 122 132 . Re-look laparotomy may also be required this has been reported in up to 13 of patients 133 . The incidence of febrile morbidity is high with rates of 5-85 in different series. Hysterectomy is indicated if conservative procedures such as embolization or uterine devascularization fail to control bleeding. The time lapse between delivery and successful surgery is the most important prognostic factor. If the primary procedure fails it is recommended that hysterectomy is performed promptly without attempts at another conservative measure 132 . In severely shocked patients with life-threatening hemorrhage hysterectomy is in most circumstances the first-line treatment 109 . Hysterectomy may therefore be associated with a higher mortality than other surgical procedures 132 . Uterine atony is the major indication for peripartum hysterectomy although other factors such as placenta accreta and abruption are frequently present 132 . Many studies have described the profound hemorrhage associated with placenta previa with a recent analysis 134 revealing blood loss greater than 3000 mL in 23 of patients with this condition. In this series approximately 10 of patients required greater than five units of blood products and hysterectomy 134 . Surgical re- exploration secondary to postoperative bleeding is needed in up to 7 of patients with placental invasion 135 136 . Other indications for peripartum hysterectomy include placenta previa uterine