Vaginal uterine artery ligation avoids high @entity190 and puerperal hysterectomy in postpartum XXXX .

@entity1 @entity548 @entity190 @entity1003 @entity8052
OBJECTIVE: To describe a novel, effective, and minimally invasive surgical technique for avoiding excess @entity190 and hysterectomy in intractable postpartum @entity548 . Previously described techniques-uterine artery ligation at various levels, hypogastric (internal iliac) artery ligation, uterine compression-all require an abdominal approach. METHODS: This procedure, which is quickly learned, is performable in the delivery room with minimal preparation, with or without bladder retraction. A 2-cm horizontal incision is made in the anterior cervix 1 cm beneath the estimated vaginocervical fold and the bladder reflected in the natural plane. Firm but gentle downward traction on the uterus to the contralateral side of the intended ligature maximizes cephalad and lateral access, permitting bilateral uterine artery ligation from laterally under direct vision and/or indirect transcervical palpation. RESULTS: Between November 1997 and June 2001, 13 @entity1 with intractable postpartum @entity548 chose the vaginal route over laparotomy as a uterus-preserving procedure. Hysterectomy proved necessary in only one case (8%) because of @entity8052 . One @entity1 has since delivered a healthy term @entity1 by cesarean, and uterine vascularization was unimpaired. CONCLUSION: The vaginal route offers a novel, simple, effective, and minimally invasive technique for treating intractable puerperal @entity548 by uterine artery ligation. Timely intervention avoids hysterectomy and @entity1003 and preserves reproductive potential.
