Postpartum hemorrhage responds to new txs. (Medical Therapy, Other Techniques).

SARASOTA, FLA.--Most cases of postpartum hemorrhage will respond to medical therapy, and several other techniques are also proving useful, Dr. Gary A. Dildy III said at a perinatal symposium sponsored by Symposia Medicus.

Among the newer--or newly revived--treatments for postpartum hemorrhage are misoprostol, the B-Lynch suture, pelvic packing, and selective arterial embolization, said Dr. Dildy, professor of obstetrics and gynecology at Louisiana State University in New Orleans.

Misoprostol, the prostaglandin [E.sub.1] analogue marketed for prevention and treatment of peptic ulcer disease, is an inexpensive (about 25 cents per tablet) and stable product shown to be of benefit in patients refractory to oxytocin. In one case series involving 14 women, a 1,000[micro]g dose of misoprostol by rectum was successful for stopping bleeding in all patients, and in another, prompt response was seen in 16 of 18 patients with uterine atony, which causes 80% of postpartum hemorrhages.

In a randomized trial, 800 [micro]g of misoprostol led to bleeding cessation in 30 of 32 patients (94%), compared with 21 of 32 patients (66%) treated with intramuscular syntometrine and intravenous oxytocin, a significant difference, Dr. Dildy said.

Use of the B-Lynch suture in patients in whom bleeding can be controlled using bimanual compression has also been effective. First reported in 1997, this suturing technique was successful in 5 of 5 patients with severe bleeding in one small case series and in 146 of 148 patients in another.

While the success rate appears good in a number of small case series, more study is needed. But it appears there is "nothing to lose" by attempting this technique to stop postpartum bleeding. If it works, the B-Lynch suture preserves fertility and prevents the need for more ...