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Christopher B-Lynch


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THE SURGICAL MANAGEMENT OF POST PARTUM HAEMORRHAGE

INTRODUCTION

The historical background of post partum haemorrhage (PPH) dates back to the 17th century. William Smelley published his famous treatise of the theory and practice of midwifery in 1752. His observations sent a clear message to practitioners of the time that haemorrhage in midwifery can be a messenger of death.

“This hazardous haemorrhage is known by the violence of the discharge, wetting fresh cloths as fast as they can be applied; from the pulse becoming low and weak, and the countenance turning pale; then the extremities grow cold, she sinks into faintings and, if the discharge is not speedily stopped, or diminished, is seized with convulsions which often terminate in death”.1

Together with the rapidity of blood loss, a loss in excess of 1000ml following delivery is used as a clinical diagnosis of major post partum haemorrhage (PPH).2 Primary PPH occurs in approximately 4% of vaginal deliveries and 6% of caesarean deliveries, with atony being the commonest cause (75–90%).3 In a study of 48,865 women who delivered in the London area in the United Kingdom, between 1997
and 1999, severe PPH was diagnosed in 6.7/1000 deliveries.4 The World Health Organisation estimated 20 million annual maternal morbidities due to haemorrhage.5 In the developing world, the risk of maternal death from PPH is approximately one in 1000 deliveries.6 PPH accounts for up to 4% of maternal deaths in the United States.7 Moreover it played a signiiificant role in 15 maternal deaths in the 2000–2002 Triennial Connnfidential Enquiry into Maternal Deaths in the United Kingdom.8

The Trienial Report on Connnfidential Enquiry into Maternal Death has become a good and reliable source of reference to understanding the efffficacy of management of PPH. In 2004 the Connnfidential Enquiry into Maternal and Child Health (Why Mothers Die 2000–2002) reaffffirmed that catastrophic haemorrhage is a persistent problem.8

Christopher B-Lynch, Department of Obstetrics and Gynaecology, Milton Keynes Hospital NHS Trust,
Standing Way, Eaglestone, Milton Keynes MK6 5LD United Kingdom

 

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