A new facilitating technique for postpartum hysterectomy at full dilatation: Cervical clamp.

BACKGROUND: Postpartum hysterectomy is a life saving emergency procedure in the management of uncontrollable severe maternal hemorrhage that every obstetrician should be closely acquainted with despite developments in medical and non-surgical interventions for obstetric hemorrhage. It can be difficult to detect the real boundaries of the cervix at full effacement and dilatation in patients who undergo emergency hysterectomy after vaginal delivery.

METHODS: Hereby we propose a simple and effective method to ease the operation by placing two atraumatic ring forceps to the anterior and posterior sides of the cervix during the preoperative vaginal examination and leave the two ring forceps while taking the patient into surgery. The boundary of the vagina and cervix will be determined with the help of the ring forceps intraoperatively, which are already placed before the operation.

RESULTS: Cervical clamp technique was successfully performed in four cases underwent to emergency postpartum hysterectomy due to uncontrollable postpartum atony. There were no postoperative complication and re-exploration for the persistent hemorrhage. Postoperative FSFI scores of the cases were 26.7, 27.4, 30.3 and 30.7.

CONCLUSION: Taking extra vaginal tissue from the lower level of the cervix may be avoided and the last stage of the total hysterectomy may be facilitated by this simple technique with ensuring of bleeding management.