SURGICAL MANAGEMENT
IN HEMORRHAGIC
GYNECOLOGIC CASES
dr. I Gde Sastra Winata, M. Biomed, Sp.OG (K) Onk
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Hemorrhage Is The No. 1 Killer In The
Operating Room All Over The World
Major cause of cardiac arrest in the operating room.
Surgical procedures, transfusion, blood supply, and
anesthetic management critical situation
If intraoperative hemorrhage seems to be critical, a state of
emergency should immediately be declared organize a
systematic approach to the ongoing problem.
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Hemorrhage Is The No. 1 Killer In The
Operating Room All Over The World
Hemorrhage was responsible for 33% of cardiac arrests and
47% of deaths. Although 2/3 of the cases of hemorrhagic
death occurred in emergency operations that were undertaken
to save the lives of bleeding patients, 1/3 of them were caused
by surgical procedures.
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Gynecologic Cases at Risk…
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Risk Factors for Bleeding
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Basic Principle Management
Basic Equipment
Pelvic
Surgical &
Anatomy
Skills Instrument
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Vascular Anatomy of The Pelvis
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Sites Vulnerable to Injuries
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Difference Between Artery
And Vein Bleeding
Artery
• Bright red/yellowish in color (high
oxygenation)
• Squirts a long way
• Pulsatile
• In time with the heartbeat
Vein
• Dark red in color (low oxygenation)
• Not pulsatile
• Low pressure
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Basic Surgical Skill
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Equipment & Instrument
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Advanced Management
Uterine Artery
Internal Illiac Artery
Common Illiac Artery Ligation
Abdominal Packing
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Uterine Artery Ligation
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Internal Iliac Artery Ligation
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Internal Iliac Artery Ligation
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Abdominal Packing
Abdominal packing is a lifesaving technique for temporary control of
severe injury and it is used in damage control surgery schedule.
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
What must we do if we found bleeding…
Don’t panic !!!
Evaluate bleeding
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
What must we do if we found bleeding…
Ligation / hecting
Avoid continuous hecting without proper
Identification of tissue
Consultation
SURGICAL MANAGEMENT IN
HEMORRHAGIC GYNECOLOGIC CASES
Conclusion
Pelvic Basic
Vascular Surgical
Anatomy Skill
Equipment &
Instrument Do Not Panic!!
Call Your Team
References
Management of Surgical Hemostasis- An Independent Study Guide
https://www.aorn.org/-/media/aorn/guidelines/tool-kits/medication-
safety/management-of-surgical-hemostasis-independent-study-
guide.pdf?la=en&hash=9FED3DF8BFDEF8B1C8D1899F8FC7BE79
McCarthy JR. Methods for assuring surgical hemostasis. In: Assisting in
Surgery: Patient-Centered Care. JC Rothrock, PC Seifert, eds. Denver,
CO: CCI; 2009:137-194
György Wéber, et al. Basic Surgical Techniques. In:
https://semmelweis.hu/mutettan/files/2020/04/BASIC-SURGICAL-
TECHNIQUES.pdf
Neveleff DJ, Kraiss LW, Schulman CS. Implementing Methods to
Improve Perioperative Hemostasis in the Surgical and Trauma Settings.
AORN J. 2010;92(5)S1-S15 https://doi.org/10.1016/j.aorn.2010.08.006
References
Steer PJ. Review The surgical approach to postpartum haemorrhage. The Obstetrician &
Gynaecologist. 2009;11:231–238
Shah M, Wright JD. Surgical intervention in the management of postpartum hemorrhage.
Semin perinatol. 2009 Apr. 33(2): 109-15.
Belfort MA. Postpartum hemorrhage: Management approaches requiring laparotomy. 2019.
Review The surgical approach to postpartum haemorrhage. Philip J Steer. The Obstetrician &
Gynaecologist. 2009;11:231–238
Selcuk I, Yassa M, Tatar I, Huri E. Anatomic structure of the internal iliac artery and its educative
dissection for peripartum and pelvic hemorrhage. Turk J Obstet Gynecol. 2018;15:126–9.
Selcuk I, Uzuner B, Boduc E, Baykus Y, Akar B, Gungor T. Step-by-step ligation of the internal
iliac artery. Turk J Gynecol Assoc. 2019 Jun; 20(2): 123–128.
Bangal V, Kwatra A, Raghav S. Role of internal iliac artery ligation in control of pelvic
hemorrhage. Pravara Med Rev 2009; 1(2).
Awonuga, A. O., Merhi, Z. O., & Khulpateea, N. (2006). Abdominal packing for intractable
obstetrical and gynecologic hemorrhage. International Journal of Gynecology & Obstetrics,
93(2), 160–163.doi:10.1016/j.ijgo.2005.12.027
Manoj Gupta, Sangeeta Nimbalkar, Punit Singla, Vinay Kumaran, Ravi Mohanka, Naimish
Mehta, Satish Saluja, A S Soin, S Nundy. 2010) Abdominal packing for surgically uncontrollable
haemorrhage, Tropical Gastroenterology 2010;31(1):61–64
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