Evaluating the efficacy of the B-lynch suture and the Bakri balloon, or both, in the treatment of severe post-partum haemorrhage Dr Ashleigh Smith Junior.

Slides:



Advertisements
Similar presentations
SALAH M.OSMAN CLINICAL MD. * It is an excessive blood loss from the genital tract after delivery of the foetus exceeding 500 ml or affecting the general.
Advertisements

Nahida Chakhtoura, M.D..  Postpartum hemorrhage (PPH): leading cause of maternal mortality worldwide  Prevalence rate: 6%  Africa has highest prevalence.
Postpartum Hemorrhage Christopher R. Graber, MD Salina Women’s Clinic 21 Feb 2012.
Postpartum Hemorrhage (PPH) and abnormalities of the Third Stage Sept 12 – Dr. Z. Malewski.
Obstetrical Simulator Curriculum Sarah Price, MD Amanda Pauley, MD MU Dept. of Obstetrics and Gynecology JCESOM Academy of Medical Educators.
Postpartum Hemorrhage HEE HEE That’s the only fake blood I could manage!!! Too messy. Jessi Goldstein MD MCH Fellow September 7,
Postpartum Hemorrhage
Major Obstetric haemorrhage Miss Melanie Tipples.
Misoprostol for PPH: An Update on Gynuity’s collaborative body of research An Update: March 2008.
MANAGEMENT OF POST PARTUM HEAMORRHAGE BY YOLAM KAMEME (MZIMBA SOUTH DISTRICT HOSPITAL) RONALD CHAGOMA (RUMPHI DISTRICT HOSPITAL) EMMANUEL NYIRENDA (NKHOTAKOTA.
Etiology and management of uterine atony Dr. Vedran Stefanovic, docent Specialist in OB/GYN, Maternal and Fetal Medicine Helsinki University Central Hospital.
ROLE OF MODIFIED B-LYNCH SUTURE IN ATONIC PPH IN CESAREAN SECTION
ALTERNATIVE METHODS FOR MANAGEMENT OF ATONIC POSTPARTUM HAEMORRHAGE
Obstetric Haemorrhage Obstetric Emergencies Empangeni Hospital 28th July 2000.
Obstetric Hemorrhage Anne McConville, MD
Introducing balloon tamponade technology in the management of postpartum haemorrhage in Malaysia 1,2,3 Associate Professor Chris Georgiou BSc (Hons) PhD.
Postpartum Haemorrhage. Definitions Primary PPH – blood loss of 500ml or more within 24hours of delivery. Secondary PPH – significant blood loss between.
A Comparative study of maternal mortality between Al-Abasia Tagali and Juba by Mahasin Hamed Haj Elsiddig.
Intra-uterine tamponade for post- partum hemorrhage management A controlled randmised trial in Vietnam ? Ho Chi Minh Ville, April 2013 Working group: -Vietnam:
Dr. M Movahedi MD. Dr. M Movahedi MD Balloon tamponade is an effective adjunct in the treatment of severe postpartum hemorrhage secondary to uterine.
The Management of Acute Necrotizing Pancreatitis
Dr. Sanchita Karmakar (Resident) Dr
Third stage of labour Dr.Roaa H. Gadeer MD.
Active Management of Third Stage of Labor
Misoprostol for Preventing Postpartum Hemorrhage and for Postabortion Care Harshad Sanghvi Patricia Stephenson MAQ 2006 Mini University, 27 0ctober 2006.
Obstetric Haemorrhage. Aims To recognise Obstetric Haemorrhage To recognise Obstetric Haemorrhage To practise the skills needed to respond to a woman.
Dr Ahmed abdulwahab. Hemorrhage is still one of the leading cause of maternal mortality all over the world DEFINITION Primary post partum hemorrhage.
Primary Postpartum Haemorrhage Max Brinsmead MB BS PhD May 2015.
PPH Prevention and Management at Health Facilities Jeffrey M. Smith Asia Regional Technical Director AME Regional Meeting Bangkok March 2010.
SEVERE ACUTE MATERNAL MORBIDITY/NEAR MISS MATERNAL MORBIDITY Sangeetagupta Seniorconsultant&HOD, Deptt of Obst.&Gynae,ESIPGIMSR,Basaidarapur.
PPH at NW. Post partum haemorrhage IndicatorWHANW 2010 N=7709 NW Public 2010 N=2329 PPH Vaginal births PPH >1500 Vaginal births.
Uterotonic drugs used for active management of the third stage of labor (AMTSL) Name of presenter Prevention of Postpartum Hemorrhage Initiative (POPPHI)
Minimally-Invasive Management of Post-Caesarian Section Bleeding by Interventional Radiology Michael S. Stecker, MD, FSIR Raj Pyne, MD Chieh-Min Fan, MD.
Postpartum Hemorrhage JEFF YAO ALI SHAHBAZ. “ ” Investing in maternal health is a wise health and economic policy decision. Women are the sole income-earners.
TEMPLATE DESIGN © The Impact of Postpartum Haemorrhage (PPH) on Maternal Morbidity A Mackeen, SY Khong Department of Obstetrics.
Severe Obstetric Haemorrhage Max Brinsmead MB BS PhD May 2015.
POPPHI – WGI presentations FIGO. 1. Lectures given on prevention & management of PPH that included FIGO/ICM joint statement and active management of the.
1. Title and Abstract Improving abstracts should be a goal not only for authors but also for editors because so few citation browsers ever read more than.
{ Postpartum Hemorrhage (PPH) What to know and do Dr. Bruno C. R. Borges Hamilton Health Sciences McMaster University OMA Anesthesia Meeting 2014.
TRIAL OF SCAR Is it ethical ? Is VBAC a legitimate aim for 2002 ? P. A Onyango- Okeyo Dept of Obstetrics & Gynaecology University of Witwatersrand.
© Mark E. Damon - All Rights Reserved This be a Presentation © All rights Reserved.
TEMPLATE DESIGN © Objectives Methods This was a retrospective cohort data analysis of all women who presented with menorrhagia.
 Obstetric Emergency  Follow Vaginal or C/S  Best definition - Diagnosed Clinically Excessive Bleeding makes patient symptomatic Other def- EBL > 500.
CWIUH Bridgette Byrne Senior Lecturer in Obstetrics and Gynaecology, RCSI and CWIUH.
DR G SIYAKA Obstetric anaesthesia OUTLINE Physiological changes of pregnancy Anaesthesia for caesarean delivery Analgesia for labour Complications.
1 |1 | Africa Regional Meeting on Interventions for Impact in Essential Maternal and Newborn Care, Addis Ababa, Feb 21, 2011 WHO Recommendations for the.
Postpartum Hemorrhage
Maternal Health at the District Hospital Family Medicine Specialist CME Oct , 2012 Pakse.
Postpartum Haemorrhage
Applying CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage 2) in a Pre- Hospital Wilderness Context Paul B. Jones PGY1.
Rare Bleeding Disorders Factor XI deficiency FX deficiency Fibrinogen deficiency Dr Niamh O’Connell The National Centre for Hereditary Coagulation Disorders,
Postpartum hemorrhage
POSTPARTUM HAEMORRHAGE
Obstetrics and Gynaecology
Post Partum Haemorrhage - Dr Thomas Carins
Invasive therapies for primary postpartum haemorrhage:
Postpartum hemorrhage
Post-Partum Haemorrhage
Medical Abortion at all Gestations
Obststric Haemorrhage Obstetric Emergencies
Postpartum Hemorrhage
Facilitator: pawin puapornpong
Menstrual and Fertility Outcomes Following Surgical Management of Post-partum Haemorrhage: A Systematic Review Doumouchtsis S.K. Nikolopoulos K Sinai Talaulikar.
Intrauterine growth restriction: A new concept in antenatal management
UOG Journal Club: January 2018
THE EFFECTIVENESS OF DOUBLE INCISOUN TECHNIGUE IN UTERUS PRESERVING SURGERY FOR PLACENTA PERCRETA Ibrahim Polat, Burak Yücel , Ali Gedikbasi, Halil.
Team training in emergency obstetrics
Practicing for Patients
DEFINITIONS : QUICK REVIEW
Obstetric Haemorrhage Case Illustration
Presentation transcript:

Evaluating the efficacy of the B-lynch suture and the Bakri balloon, or both, in the treatment of severe post-partum haemorrhage Dr Ashleigh Smith Junior House Officer, RBWH

Case 24 y/o G1P1 has a ‘PPH’ How do you know it is a PPH? Remember : – Tissue, Tone, Trauma, Thrombin What can you do about it?

Post Partum Haemorrhage Primary: >500mL’s EBL within the first 24 hours after delivery Secondary: >500mL’s EBL from 24hours to 6 weeks post delivery.

Medical Treatment of PPH Active management of the third stage IV 5 I.U. oxytocin IV/IM Ergometrine 250 microg Oxytocin infusion (40 in 1L) PR Misoprostol Intramyometrial PGF2alpha

What if Medical Management FAILS!?!?! Depends on the clinical situation Open or closed abdomen? Does the woman want a hysterectomy?

What if they Fail!? Hysterectomy? Can we try anything else???

Using both B-lynch and Bakri? A novel concept aka “uterine sandwich” If one fails in isolation, perhaps go on and try the combination as ‘3 rd line’ after – Medical management – Bakri OR B-kynch – Both

How about a “uterine sandwich?” Few trials available, some are very promising QLD guidelines for PPH management : “insufficient evidence to support use of combined balloon tamponade with the B- lynch suture.”

My Research…. A retrospective case study at RBWH all women who had a PPH and insertion of either – B-lynch suture or – Bakri balloon, or – both, between Jan 2009 – Dec 2013.

Please note…. If anyone received “both,” that means they failed the b-lynch or the bakri Therefore it is a very serious PPH and a more tenuous cohort/clinical situation

Cohort 97 cases of PPH occurred in which medical therapy alone failed.

What type of Birth?

Primary vs Secondary PPH

Results 7 emergency hysterectomies in the study No mortalities

Hysterectomy Patients

What about the “sandwich!?” 5 of the 9 patients treated with ‘the uterine sandwich’ went on to hysterectomy Is that bad??? – Bakri = 95% success – B-lynch = 100% success – Both ………….. 44% success

Conclusions Bakri and B-lynch suture = highly effective in terminating PPH when medical therapy alone fails. ‘Uterine sandwich’ appears to be an effective option to trial in an effort to avoid hysterectomy. Need clear stepwise PPH guidelines

Thank you! References: 1.Gronvall M, Tikkanen M, Tallberg E, et al. Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases from a tertiary teaching hospital. Acta Obstet Gynecol Scand. 2013; 92(4): Gao, Y., Wang Z., Zang J., et al. Efficacy and safety of intrauterine Bakri balloon tamponade in the treatment of postpartum hemorrhage: a multicenter analysis of 109 cases. Zhonghua Fuchanke Zazhi, 2014; 49(9): Liu S, Mathur M, Tagore S. Complications and pregnancy outcome following uterine compression suture for postpartum haemorrhage: a single centre experience. Journal of Obstetrics and Gynaecology, 2014; 34(5): Kaya B, Tuten A, Daglar K, et al. B-Lynch uterine compression sutures in the conservative surgical management of uterine atony. Arch Gynecol Obstet, 2014; 291(5): Diemert A, Ortemeyer G., Hollwitz B, et al. The combination of the intrauterine balloon tamponade and b-lynch procedure for the treatment of severe postpartum hemorrhage, Am J Ostet Gynecol, 2012; 206(1): Yoong W, Ridout A, Memtsa M, et al. Application of uterine compression suture in association with intrauterine balloon tamponade ('uterine sandwich') for postpartum hemorrhage. Acta Obstet Gynecol Scand, 2012; 91(1): Chan L, Lo T, Lau W, et. al. Use of second-line therapies for management of massive primary postpartum hemorrhage. Int J Gynecol Obstet, 2013; 122(3): 238–243.