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Case Reports
. 2020 Nov 26:37:279.
doi: 10.11604/pamj.2020.37.279.26788. eCollection 2020.

[Uterine necrosis following uterine compressions in combination with vascular ligation during postpartum hemorrhage: a case report]

[Article in French]
Kamal El Moussaoui  1 , Najia Zraidi  1 , Aziz Baidada  1 , Aicha Kharbach  1
Affiliations
Case Reports

[Uterine necrosis following uterine compressions in combination with vascular ligation during postpartum hemorrhage: a case report]

[Article in French]
Kamal El Moussaoui et al. Pan Afr Med J. .

Abstract
in English, French

Delivery hemorrhage is the leading cause of maternal mortality in Morocco. It is an obstetric emergency requiring early, effective and multidisciplinary management in patients with severe postpartum bleeding resistant to medical treatment. Advances in interventional radiology and especially, in surgical techniques have provided safe and effective alternatives to hemostasis hysterectomy . We here report a case of uterine necrosis following conservative surgical treatment of delivery hemorrhage based on B-Lynch uterine compression suture combined with Tsirulnikov triple vascular ligation. The patient had sepsis on day 4 after delivery associated with fever and pelvic pain and biological inflammatory syndrome which worsened 48 hours after the onset of abdominal contracture. Abdomopelvic scanner, showed gas bubbles in the uterine myometer suggestive of necrosis. Exploratory laparotomy was performed, which objectified complete necrosis of the uterus. Uterine compression sutures are surgical techniques which play a major role in the therapeutic armamentarium of postpartum hemorrhage during cesarean section. It allows, in addition to or as an alternative to vascular ligation, the preservation of patient's fertility, but it also requires maximum caution and monitoring of complications, the most serious of which is uterine necrosis.

L'hémorragie de délivrance reste la première cause de mortalité maternelle au Maroc, c´est une urgence obstétricale qui nécessite une prise en charge rapide, efficace et multidisciplinaire. Dans les cas d´hémorragie du post-partum grave rebelle au traitement médical, les progrès de la radiologie interventionnelle et surtout des techniques chirurgicales ont fourni des alternatives sûres et efficaces à l'hystérectomie d´hémostase. On rapporte un cas de nécrose utérine suite à un traitement conservateur chirurgicale de l´hémorragie de délivrance à base d´une combinaison de technique de compression utérine type B-Lynch et triple ligature vasculaire de Tsirulnikov. La patiente a présenté un tableau de sepsis a J4 du post-partum avec un état fébrile et des douleurs pelviennes et un syndrome inflammatoire biologique qui s´est aggravé 48 heures après par l´apparition de contracture abdominale. Le scanner abdomino-pelvien a montré des bulles de gaz dans le myomètre utérin évoquant une nécrose. Une laparotomie exploratoire a été réalisée, l'exploration a révélé une nécrose complète de l'utérus. Les techniques chirurgicales des sutures de compression utérine jouent un rôle majeur dans l'arsenal thérapeutique de l'hémorragie post-partum pendant la césarienne. Elle permet, en complément ou en alternative à la ligature vasculaire, la préservation de la fertilité de la patiente mais elle nécessite également une prudence et une surveillance maximale des complications dont la plus grave est la nécrose utérine.

Keywords: Delivery hemorrhage; case report; uterin upholstery; uterine atonia; uterine necrosis.

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Conflict of interest statement

Les auteurs ne déclarent aucun conflit d´intérêts.

Figures

Figure 1
Figure 1
image peropératoire montrant la face antérieure de l´utérus nécrosé et surinfecté
Figure 2
Figure 2
la pièce d´hystérectomie montrant l´importance de la nécrose et de la surinfection de l´utérus
See this image and copyright information in PMC

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