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Hypogastric Artery Ligation for Postpartum Hemorrhage

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drvivekpatkar

Hypogastric Artery Ligation

Saúde e medicina
1 de 39
Dr. Vivek D. Patkar M.D., D.G.O Ex Honorary Professor LTMMC & LTMGH Sion, Mumbai.
Definition of PPH ,[object Object],[object Object],[object Object]
Statistics ( L.T.M.G.H ) from 1999 to 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Statistics ( L.T.M.G.H ) from 1999 to 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLASSES OF HAEMORRHAGE ,[object Object],[object Object],[object Object],Class I Class II Class III Class IV % Blood Loss 15 20 - 25 30 - 35 40 Pulse Normal 100 120 > 140 Systolic BP Normal Normal 70 - 80 < 60 Mean arterial Pressure 80 - 90 80 - 90 50 – 70 < 50
Statistics Sample Years: 2001 & 2002 PPH Causes No. UTERINE : Atony Retained placenta Placenta praevia Abruptio placenta Adherent placenta Rupture Ut and Lacerations Inversion of Uterus 56 28 14 1 NON UTERINE : Lower gen tr. Lacer Br Lig Hematoma Coagulopathy 10 2 5 Total 116 INTRACTABLE PPH Causes No. UTERINE : Atony Retained placenta Placenta praevia Abruptio placenta Adherent placenta Rupture Ut and Lacerations Inversion of Uterus 8 7 5 1 NON UTERINE : Lower gen tr. Lacer Br Lig Hematoma Coagulopathy 2 1 2 Total 26
PRELUDE TO SURGERY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],TACTICAL ANALOGUE
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
71 UAL’s done ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
UAL ,[object Object],[object Object],[object Object]
Procedure ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANATOMY of HAL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANATOMY of HA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANATOMY of HA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Division of Hypogastric Artery (Gross CM) Post Division Ant Division Parietal Parietal Visceral Ilio lumbar Obturator Obl. Umbelical Lateral sacral Int pudendal Uterine Superior Gluteal Inf Gluteal Vaginal Sup. Vesical Inf. Vesical M. Haemorrhoidal
Collateral Circulation ( Gross) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Haemodynamics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Haemodynamics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Procedure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Procedure ( Contd) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Procedure ( Contd) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Int. Iliac/Success rate Authors Year Method No of Women Success Rates Evans et al 1985 Internal iliac artery ligation 14 6/14 (42.8%) Fernandez et al 1988 Internal iliac artery ligation 8 8/8 (100%) Chattopadhyay et al 1990 Bilateral Hypogastric artery ligation 29 19/29 ( 65%) Ledee et al 2001 Bilateral Hypogastric artery ligation 48 43/48 (89.5%)
Failures (2% -- 8%) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Incase of Failures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THANK YOU In Surgical Impasse and Intractable PPH the best defense is swift offense, viz. HAL - Michael Smith
 

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Hypogastric Artery Ligation for Postpartum Hemorrhage

  • 1. Dr. Vivek D. Patkar M.D., D.G.O Ex Honorary Professor LTMMC & LTMGH Sion, Mumbai.
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  • 6. Statistics Sample Years: 2001 & 2002 PPH Causes No. UTERINE : Atony Retained placenta Placenta praevia Abruptio placenta Adherent placenta Rupture Ut and Lacerations Inversion of Uterus 56 28 14 1 NON UTERINE : Lower gen tr. Lacer Br Lig Hematoma Coagulopathy 10 2 5 Total 116 INTRACTABLE PPH Causes No. UTERINE : Atony Retained placenta Placenta praevia Abruptio placenta Adherent placenta Rupture Ut and Lacerations Inversion of Uterus 8 7 5 1 NON UTERINE : Lower gen tr. Lacer Br Lig Hematoma Coagulopathy 2 1 2 Total 26
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  • 22. Division of Hypogastric Artery (Gross CM) Post Division Ant Division Parietal Parietal Visceral Ilio lumbar Obturator Obl. Umbelical Lateral sacral Int pudendal Uterine Superior Gluteal Inf Gluteal Vaginal Sup. Vesical Inf. Vesical M. Haemorrhoidal
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  • 32. Int. Iliac/Success rate Authors Year Method No of Women Success Rates Evans et al 1985 Internal iliac artery ligation 14 6/14 (42.8%) Fernandez et al 1988 Internal iliac artery ligation 8 8/8 (100%) Chattopadhyay et al 1990 Bilateral Hypogastric artery ligation 29 19/29 ( 65%) Ledee et al 2001 Bilateral Hypogastric artery ligation 48 43/48 (89.5%)
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  • 38. THANK YOU In Surgical Impasse and Intractable PPH the best defense is swift offense, viz. HAL - Michael Smith
  • 39.