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A New Protocol for Determining Intervention with Trans-Catheter Arterial Embolization or Surgical Hemostasis for Obstetric Hemorrhage

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Open Journal of Obstetrics and Gynecology 2015年第3期5卷 128-134页

作者： Mai Myoga Kazuaki Yoshimura toru hachisuga Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan Wakamatsu Hospital University of Occupational and Environmental Health Kitakyushu Japan

Objectives: The aim of this study is to introduce protocols for choosing trans-arterial embolization (TAE) or surgical hemostasis as an initial therapy for obstetric hemorrhage. Materials and Methods: From 2002 to 2011 at our hospital, the medical records of the patients who underwent TAE or surgical hemostasis for obstetric hemorrhage were reviewed to assess the following data: The causes of obstetric hemorrhage, Shock Index (SI) and obstetrical disseminated intra-vascular coagulation (DIC) score, amount of bleeding, transfusion, and operation time. Results: Twenty-five patients underwent TAE and six underwent surgical hemostasis. SI and obstetrical DIC score of the TAE group were 1.0 (0.4 - 2.2) and 6.0 (1 - 32), respectively. They were significantly lower than those of the surgical hemostasis group (SI: 1.6, obstetrical DIC score: 12.5, p < 0.05). Though the hemorrhage could be controlled sufficiently in 23 cases of the TAE group, 5 cases went into shock during TAE. The SI and obstetrical DIC score of shock group were 1.2 (1 - 2) and 10 (2 - 32), respectively. Conclusion: Though TAE is a useful therapy to control obstetric inevitable hemorrhage, special attention should be paid to the vital signs during TAE, especially in cases where SI and/or obstetrical DIC score are higher than 1.2 and 10, respectively.

关键词： Obstetric Hemorrhage Trans-Catheter Arterial Embolization (TAE) Surgical Hemostasis Obstetrical DIC Score Complications

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Severe Pelvic Organ Prolapse with Large Vaginal Mucosal Defect Underwent Laparoscopic Shull’s Uterosacral Ligament Colpo-Suspension and TVM Operation by Two Stage Surgery

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Open Journal of Obstetrics and Gynecology 2017年第4期7卷 395-399页

作者： Yasuyuki Kinjo Kazuaki Yoshimura Hitomi Nakagawa Kazuaki Nishimura toru hachisuga Department of Obstetrics and Gynecology Wakamatsu Hospital of University of Occupational and Environmental Health Kitakyushu Japan Department of Obstetrics and Gynecology University of Occupational and Environmental Health Kitakyushu Japan

A 75-year-old woman complained of anuria and a sense of discomfort with severe pelvic organ prolapse (POP). We planned tension-free vaginal mesh (TVM) surgery after curing mucosal defects and completing treatment for diabetes mellitus. Anuria and pyelonephritis relapsed repeatedly due to the failure of ring pessary therapy. Surgical treatment was required emergently. We performed a total laparoscopic hysterectomy and uterosacral ligament colpo-suspension (Shull’s method). Although the vaginal apex was supported to a good position, cystocele occurred six months after the initial surgery. A TVM procedure for recurrent cystocele was performed after curing the mucosal defects, and after the improvement of glycemic control. Transvaginal native tissue repair has the advantages of low risk of ureter injury, firm colpo-suspension, and no need for mesh usage. On the other hand, it is not good at treating cystocele. Transvaginal native tissue repair should prove to be a useful surgical option for apical support without mesh.

关键词： Pelvic Organ Prolapse Intravaginal Mucosal Defect Laparoscopic Native Tissue Repair Transvaginal Mesh Surgery

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