La technique de la césarienne : recommandations pour la pratique clinique du Collège national des gynécologues obstétriciens français

Sentilhes, Loïc; Schmitz, Thomas; Madar, Hugo; Bouchghoul, Hanane; Fuchs, Florent; Garabédian, Charles; Korb, Diane; Nouette‐Gaulain, Karine; Pécheux, Océane; Sananès, Nicolas; Sibiude, Jeanne; Sénat, Marie-Victoire; Goffinet, François

doi:10.1016/j.gofs.2022.10.002

Cited by 2 publications

(1 citation statement)

References 173 publications

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“…The intraoperative thorough control of haemostasis and post-operative universal antibiotic administration constitute the basis of prophylactic measures to prevent post-operative haemorrhagic complications following caesarean section (4). In addition, the non-closure of the visceral peritoneum after suturing the uterine incision allowing the vesicouterine pouch to communicate with the peritoneal cavity may be a recommendation to avoid formation of bladder flap hematoma (12). Furthermore, eschewing superficial incising and dissecting the peritoneal lining to separate the urinary bladder from the lower uterine segment before uterine incision, which results in the avoidance of bladder flap formation, may currently be a weak recommendation to prevent bladder flap haematoma and reduce maternal morbidity after performing a caesarean section (12).…”

Section: Discussionmentioning

confidence: 99%

Large bladder flap haematoma following a caesarean section associated with right hydroureteronephrosis: A case report and a mini‑review of the literature

Thanasa,

Kamaretsos

et al. 2023

Med Int

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Post-caesarean section bladder flap haematoma is a rare postpartum complication. There are currently no specific treatment protocols, at least to the best of our knowledge. In general, the failure of conservative treatment with antibiotics requires the re-operation and surgical drainage of the haematoma. The present study describes the case of a primiparous pregnant woman who, at 40 weeks of pregnancy, delivered by caesarean section. On the 3rd post-operative day, the puerperant, haemodynamically stable, developed febrile infection. During the evaluation, the presence of bladder flap haematoma associated with moderate right hydroureteronephrosis was found. The failure of conservative management led to the decision to perform a re-laparotomy 1 week later. During the surgery, a large bladder flap haematoma was found with a retroperitoneal extension into the right parametrium. The surgical drainage of the haematoma and thorough haemostasis in the area of the vesicouterine pouch was performed. The patient was discharged from the clinic on the 5th post-operative day following the re-operation. After 2 weeks, an ultrasound revealed the complete repair of the lesions in the vesicouterine pouch and the right kidney. In the present study, a brief review of literature is also provided regarding the diagnostic and therapeutic management of patients with post-caesarean section bladder flap hematoma.

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Section: Discussionmentioning

confidence: 99%

Large bladder flap haematoma following a caesarean section associated with right hydroureteronephrosis: A case report and a mini‑review of the literature

Thanasa,

Kamaretsos

et al. 2023

Med Int

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Maternal mortality due to obstetric hemorrhage by surgical injury during cesarean section: A nationwide study

de Vries,

Verspyck,

Morau

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionObstetric hemorrhage remains a largely preventable cause of maternal mortality globally. The contribution of uterine atony to hemorrhage‐related maternal mortality has decreased in France, while the contribution of other causes of obstetric hemorrhage such as surgical injury during cesarean has been reported to increase. However, little evidence exists regarding the risk factors and care processes of women who died from this cause of hemorrhage. Therefore, we aimed to describe the clinical profile, underlying mechanisms, and preventability factors among women who died from obstetric hemorrhage by surgical injury during cesarean section.Material and MethodsNationwide analysis of all hemorrhage‐related maternal deaths by surgical injury during cesarean in France identified by the nationwide permanent enhanced maternal mortality surveillance system (ENCMM) between 2007 and 2018. We described the characteristics of the women, delivery hospitals, circumstances of hemorrhage, features of obstetric and resuscitation/transfusion care, and main preventability factors.ResultsBetween 2007 and 2018, hemorrhage‐related maternal mortality in France decreased from 1.6/100 000 live births (95% CI 1.1–2.2) (39/2 472 650) in 2007–2009 to 0.8/100 000 live births (95% CI 0.5–1.3) (19/2 311 783) in 2016–2018. Hemorrhage‐related maternal mortality ratio due to surgical injury during cesarean increased from 0.08 (95% CI 0.01–0.3) (2/2 472 650) to 0.2 (95% CI 0.07–0.5) (5/2 311 783) per 100 000 live births. Among the 18 women who died from surgical injury during cesarean over the 12‐year study period, we report a high prevalence of obesity (67%, 12/18), previous cesarean (72%, 13/18), and second‐stage cesareans (56%, 10/18). In 22% (4/18), cesarean section was performed in a hospital providing <1000 births annually, with no blood bank (39%, 7/18) or no adult intensive care (44%, 8/18) on‐site. Overall preventability of deaths was 94% (17/18). Main preventability factors were related to delay in hemorrhage diagnosis (77%, 14/18) due to late recognition of abnormal parameters (33%, 6/18) and late bedside ultrasound (56%, 10/18), and delay in management due to insufficient surgical skills (56%, 10/18).ConclusionsIn France, surgical injury during cesarean section is an increasing, largely preventable contributor to hemorrhage‐related maternal mortality, as other causes of fatal hemorrhage have become less frequent. The profile of these women showed a high prevalence of obesity, previous cesarean, second‐stage cesarean, and delivery in hospitals with limited medical and surgical resources, which suggests explanatory mechanisms for the fatal outcome and opportunities for prevention.

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La technique de la césarienne : recommandations pour la pratique clinique du Collège national des gynécologues obstétriciens français

Cited by 2 publications

References 173 publications

Large bladder flap haematoma following a caesarean section associated with right hydroureteronephrosis: A case report and a mini‑review of the literature

Large bladder flap haematoma following a caesarean section associated with right hydroureteronephrosis: A case report and a mini‑review of the literature

Maternal mortality due to obstetric hemorrhage by surgical injury during cesarean section: A nationwide study

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