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วันชัย จันทราพิทักษ์
Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
วิสุทธิ์ อนันตสกุลวัฒน์
Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
สาวิตรี สุวิกรม
Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
เรณู วัฒนเหลืองอรุณ
Labour Room, Charoenkrung Pracharak Hospital, Bangkok, Thailand
Abstract
Introduction: Postpartum Hemorrhage (PPH) is a major cause of postpartum maternal mortality and still poses a problem today. As a whole, the incidence of PPH has been on a gradual decline. On the contrary, the incidence of atonic PPH has been persistently rising throughout the past 10 to 20 years in many developed countries. The causes and risk factors of atonic PPH have not been distinctly identified, but it is believed that lower uterine segment atony (LUSA) plays a crucial role in the occurrence of atonic PPH.
Objectives: To analyze the correlation between lower uterine segment atony and atonic PPH and to determine the effectiveness of lower uterine segment compression in reducing LUSA and atonic PPH.
Method: This study is a literature review of researches which utilized LUSC in treatment and prevention of PPH successfully. LUSC is found to be a direct treatment of lower uterine segment bleeding/atony after considering the incidence of PPH, postpartum blood loss, and other complications. The treatment group which received LUSC had significantly lower rate of PPH and complications as compared to the control group.
Conclusion: LUSA causes atonic PPH via continuous excessive bleeding and, subsequently, uterine hypoperfusion and uterine hypoxia. Uterine hypoxia contributes to uterine relaxation irresponsive to uterotonics. As a result, uterine atony follows and ultimately leads to PPH.
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