What is Postpartum Hemorrhage?
Have you heard of Postpartum Hemorrhage in pregnancy? According to population-based studies, 5 in every 100 pregnancies have the risk of PPH also known as postpartum hemorrhage, which is a condition causing profuse loss of blood, leading to the death of many mothers. Recent reports suggest that pregnancy-related deaths due to PPH are rising. Usage of a PPH cannula is a safe and simple technique for preventing and treating Postpartum Hemorrhage, thereby decreasing maternal mortality and morbidity.
Case Studies Conducted in PPH
A study was conducted for a period of 2 years in a low-resource maternity hospital which has around 1000 deliveries per year, forty women who had normal vaginal deliveries and fifteen women who had LSCS were included in the data collection. Irrespective of treating them with uterotonic drugs, all 55 mothers developed PPH. Out of the 55 mothers, four developed atonic PPH resulting in blood loss of more than 1500 ml.
Blood pressure, pulse rate, hemoglobin hematocrit, platelet count, clotting time, and bleeding time were noted. An efficiently designed PPH cannula of 12 mm in diameter and 25 cm in length with multiple perforations of 4 mm diameter at the distal 12 cm of the cannula was inserted into the uterus through the vagina to reach the fundus. The cannula was connected to a suction apparatus, and negative pressure of 700 mm Hg was created.
How does PPH Cannula Stop Bleeding?
Negative suction results in the aspiration of blood from the uterine cavity into the cannula. Around 50–100 ml of blood can be sucked in and the suction will be maintained for up to 30 minutes. Cessation of blood flow occurs once the blood is completely sucked out, and the uterus is contracted back. In five cases loss of blood was observed even after using the cannula. This was due to the presence of vaginal tears. In such cases suturing will be performed.
In two cases where there was a heavy blood flow, the cannula got blocked by blood clots. Even though the suction was maintained blood flow was observed in them and blood wasn’t entering the cannula. Immediately the cannula was replaced with another, negative pressure was created inside the cannula and the blood flow stopped. Therefore, always have an additional set of cannulas in such emergencies.
In both cases, blood flow persisted even after the suction was supplemented. On re-checking, the placement of the cannula was faulty as it wasn’t reaching the fundus. Hence the suction was discontinued and the cannula was correctly positioned, after which suction was reapplied and the over-flowing blood was stopped. When blood overflows or oozing continues despite suction, it is typically coming from the cervix because the cannula’s apertures are inside the uterus and useless in the cervix. This condition can be stopped by suturing or by the pack.
Results of the Negative Suction Produced in the Uterine Cavity
The strong negative suction exerted in the uterine cavity by this special cannula results in the removal of blood and blood clots. The inner surface of the uterine cavity gets strongly sucked by the cannula. Arterioles and sinusoids are among the bleeding vessels that are mechanically sealed up by being drawn into the cannula’s openings together with all other bleeding vessels. Within 30–40 minutes, clot development causes the bleeding locations to be permanently shut. This is a very effective method to manage and treat PPH because it is safe, sure, inexpensive, and easy to do.
Instead of using the suction machine, a mechanical suction unit of ventouse or MVA syringe can be used. There were no complications and no failure observed while using the device. This life-saving procedure helps bring down maternal mortality.
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