tailieunhanh - Consequences of postpartum hemorrhage

Significant postpartum hemorrhage may occur immediately after delivery, or may be delayed weeks or months. In either case, a Cesarean or later postpartum hysterectomy may be lifesaving. The uterus will normally be sent for laboratory examination. To facilitate a useful surgical pathology report, the pathologist must be given details of the antepartum course and delivery. Considering how uncommon these specimens are, direct communication between pathologist and clinician is recommended. The aim of this chapter is to provide a structured approach to the analysis of the specimen, in order to permit a clinically relevant and pathologically sound diagnosis. . | Section VIII Consequences of postpartum hemorrhage 36 PATHOLOGY OF THE UTERUS P. Kelehan and E. E. Mooney BACKGROUND AND AIMS Significant postpartum hemorrhage may occur immediately after delivery or may be delayed weeks or months. In either case a Cesarean or later postpartum hysterectomy may be lifesaving. The uterus will normally be sent for laboratory examination. To facilitate a useful surgical pathology report the pathologist must be given details of the antepartum course and delivery. Considering how uncommon these specimens are direct communication between pathologist and clinician is recommended. The aim of this chapter is to provide a structured approach to the analysis of the specimen in order to permit a clinically relevant and pathologically sound diagnosis. CLINICAL CORRELATION The parity and gestation should be provided. Any abnormality of the clinical course in particular pre-eclampsia or polyhydramnios may be of relevance. Magnetic resonance imaging MRI may have been performed for fibroid placenta creta or congenital abnormality and these images should be reviewed. A history of the use of instruments such as forceps is important. The clinical appearance of the uterus at operation may provide valuable information on atony. Any therapeutic measures undertaken such as uterine massage or compression suture should be noted along with transfusion and fluid replacement. A description of the surgery will help the pathologist to interpret the tears and sutures that characterize these specimens. The patient s postoperative condition will help to guide sampling in the event that amniotic fluid embolism is a consideration. Finally the placenta must also be available for examination. GROSS EXAMINATION Photography is essential at each step of the dissection with notes as to what each picture is intended to show. Without a clinical input however much effort may be wasted on documenting features of little relevance at the expense of missing more important ones. A