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
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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
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Gynaecologist. 2009;11:231–238
Shah M, Wright JD. Surgical intervention in the management of postpartum hemorrhage.
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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.
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hemorrhage. Pravara Med Rev 2009; 1(2).
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Manoj Gupta, Sangeeta Nimbalkar, Punit Singla, Vinay Kumaran, Ravi Mohanka, Naimish
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