Complex Cesarean Section and Postpartum Hemorrhage Management

These vocabulary flashcards cover surgical protocols, anatomical classifications of uterine sectors, and clinical management strategies for complex cesarean sections and postpartum hemorrhage as described in the FIGO special article.

Complex Cesarean Section

A procedure involving surgical difficulties due to complications from previous cesareans (such as myometrial defects and peritoneal adhesions) or a high risk of postpartum hemorrhage.

Cesarean Scar Defects (CSDs)

An area of permanent loss of the normal structure of the lower uterine segment, such as an isthmocele or niche, resulting from inadequate healing after a previous cesarean.

Placenta Accreta Spectrum (PAS)

A condition involving abnormal placental intrusion into the myometrium, significantly increasing the risk of life-threatening intraoperative bleeding.

Lower Uterine Segment (LUS)

The lower portion of the uterus that is subject to thinning and scarring from previous surgeries and where bleeding associated with placenta previa occurs.

Paramedian Abdominal Access

A surgical approach using the preperitoneal plane through a transverse suprapubic skin incision to release the bladder from the abdominal wall bilaterally in cases of dense adhesions.

Pelosi Maneuver

Also known as retrovesical bypass, it involves introducing the surgeon's index fingers from the parametrial space to the medial paravesical space and then into the retrovesical space.

Patient Blood Management (PBM)

The application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss.

Pillar 1 of PBM

Strategies aimed at optimizing perioperative erythropoiesis.

Pillar 2 of PBM

Methods used for minimizing surgical and nonsurgical (iatrogenic) blood loss and correcting coagulopathy.

Pillar 3 of PBM

Support for the woman while appropriate treatment is initiated, including the application of restrictive transfusion thresholds.

Colpouterine Arteries

An arterial pedicle reaching the lower part of the uterus that derives from the vaginal arteries; these are essential for blood supply to the lower uterine segment.

Uterine Vascular Sector $S1$

The region corresponding to the uterine body, fundus, and upper segment, primarily supplied by the uterine and ovarian arteries.

Uterine Vascular Sector $S2$

The region corresponding to the lower uterine segment and cervix, primarily supplied by the colpouterine arteries.

Uterine Vascular Sector $S3$

The region corresponding to the vagina, supplied by vaginal arteries which are branches of the internal pudendal artery.

B-Lynch Suture

A recognized uterine compression suture designed to compress the upper part of the uterus ($S1$ sector) in cases of uterine hypotonia.

Ho-Cho or B-Lynch 2 Sutures

Lower uterine segment compressive sutures indicated for bleeding in the $S2$ sector, often secondary to placenta previa.

Primary Hemostasis

Immediate and temporary control of blood loss using simple measures like manual aortic compression (internal or external) or a uterine tourniquet.

Secondary Hemostasis

The application of a definitive control strategy for bleeding after initial temporary measures have stabilized the situation.

Vesicouterine Plica

The peritoneal fold between the bladder and the uterus; hysterotomy performed $2\,cm$ below this level in advanced labor is associated with higher scar defect incidence.