Surgical methods aimed at arresting obstetric hemorrhage include: application of hemostatic sutures by B-Lynch method, ligation of arteries (internal iliac, uterine and ovarian arteries) and embolization of pelvic vessels.
6.1. PLACING HEMOSTATIC B-LYNCH SUTURES
A transverse incision is made in the lower uterine segment with additional control examination of uterine cavity.
The needle enters the uterine cavity 3 cm below the incision and lower than the lateral edge of the uterus in the lower segment and exits 3 cm above the edge of the incision and 4 cm medial to the uterine side.
Next, suture thread (vicryl, polyglactin, monocryl or other absorbable strong suture material) is thrown over the uterine fundus.
On the posterior wall at the level of sacral ligaments, the needle enters and exits in the transverse direction above the right and left sacrouterine ligaments (widely, so that they do not cut through).
Then the thread is returned to the anterior wall over the uterine fundus.
The entry site of the needle on the anterior wall is chosen 3 cm higher, and the exit site is 3 cm lower than the transverse incision. Sutures are placed 4 cm medial to the uterine side.
Then the threads are pulled together, knotted. Pulling is performed sequentially for 1-2 minutes until the full effect is achieved.
The incision in the lower uterine segment is closed with a single-row suture. The effect of suture placement lasts for 24-48 hours. This suture is called "backpack suture" (fig. 6.1).
There are other types of hemostatic sutures that are called (fig. 6.2): "square" (by Cho), "mattress" (Hamanu) and Z-shaped, tightening.
All of them can be placed on the overly stretched lower uterine segment, the area of the distended and bleeding area of uterus. Sometimes unsutured