Case notes
When postpartum hemorrhage does not respond to medical treatment, arterial embolization or surgery is required. The surgical techniques of uterine compression or vascular ligation are attempted before resorting, if necessary, to hysterectomy. We have evaluated the efficacy of total uterine ligation, which is a new technique that combines vascular and uterine compression and avoids invasion of the uterine cavity, which can cause synechiae.
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Conclusions
After laparotomy, clots are removed from the uterus by manual compression of the uterine wall or by hysterotomy. Placement of layered circular absorbable sutures (polyglactin 910, size 2) compresses the uterine body and principal afferent arteries (uterine arteries and the arteries of the ovarian and round ligaments) during a single intervention. The circular ligatures of the upper layers cross the uterine body in the lateral walls without infringing on the integrity of the uterine cavity or compressing the exterior uterine artery ( Figures 1-3 ). One of the upper ligatures simultaneously compresses the uterine body and the vessels of the ovarian and round ligaments. A lower ligature goes through the broad ligament of the uterus to compress both of the uterine arteries and the lower segment simultaneously.
