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Re: Cytotec and hypotonic uterusFrom: Diane Petersen (peter261@gold.tc.umn.edu)Wed Apr 12 20:21:55 2000
> I'd have tried bilateral bilateral uterine vessel ligation (O'Leary > sutures) or hypogastric plus ovarian artery ligation before converting > to subtotal hysterectomy in this case. We recently had a severe uterine > atony during a C/S in a 18 year old mother with a twin pregnancy. > Hemorrage was controlled only after complete ligation of all branches of > the uterine arteries including the cervico-vaginal.Abdomen was closed > with a totally uncontracted uterus without any bleeding per vaginam.The > patient had already received two tablets of Cytotec (200 mg)per rectum. > The uterus contracted ca 2.5 hours after the operation with a sudden > gush of vaginal bleeding and remained contracted thereafter. She left > the hospital without any complications on the 4th post-op day. > > -- > H.Fehmi Yazıcıoğlu, > Clinical Chief of Staff, > Süleymaniye Maternity Hospital > Istanbul,Turkey > I agree with an attempt at vascular ligation before doing the hyst. I had ligated the uterine arteries (sorry, forgot to include that in my earlier description of events). I ligated them after the first two doses of Hemabate. With the significant DIC I don't know that she could (or that I could) have tolerated anything less than absolute hemostasis before we closed the abdomen. We went through a lot of blood products and had a significant blood loss intra-operatively. I did not want to open too many new tissue spaces with the DIC and, therefore, decided to not do a hypogastric ligation. Thanks for the feedback. I greatly appreciate the follow-up on this thread.
-- Diane Petersen MD
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