INTRAUTERINE IRRIGATION WITH PROSTAGLANDIN-F2-ALPHA FOR MANAGEMENT OFSEVERE POSTPARTUM HEMORRHAGE

Background. Severe postpartum hemorrhage is a significant contributor to maternal morbidity and mortality. The use of prostaglandin F-2-alph a. to control severe postpartum hemorrhage may avert surgery for the c ontrol of bleeding. Methods. After ruling out the possibility of genit al tract injuries, 18 patients with severe postpartum hemorrhage cause d by uterine atony were enrolled in the study. None of the patients re sponded to treatment with oxytocin, methylergonovine, or uterine massa ge. A Foley catheter was introduced into the uterine cavity and the ba lloon was inflated with 5 ml sterile saline solution. The catheter was connected to an infusion line of 500 ml saline solution containing 20 mg prostaglandin F-2-alpha. The solution was infused at a rate of 3-4 ml/minute for the first 10 min, and then reduced to 1 ml/minute for a period of 12-24 hours. Results. In 17 patients (94.4%) bleeding cease d within several minutes of initiation of intrauterine prostaglandin F -2-alpha infusion, the uterus was firmly contracted and uterine bleedi ng did not recur. In one patient with placenta increta bleeding contin ued and hysterectomy was performed. None of the patients had any side effects. Conclusions. Intrauterine irrigation with low concentrations of prostaglandin F-2-alpha is a simple, rapid and effective treatment for severe postpartum hemorrhage and facilitates constant and continuo us hemostasis. Moreover, the minute dosage used eludes potentially com plicating side effects.