Objective: To investigate the prevention and management of severe bleeding during gynecological operations.
Methods: A retrospective study of 85,505 gynecological operations from 21 hospitals in China during the period of 1990-1999 was analyzed.
Results: There were 683 cases with bleeding more than 1,000 ml during surgery, an incidence of 0.80% (range 0.07%-6.98%). Operation for removal of malignant ovarian tumor was the commonest cause of severe bleeding (42.31%); followed by cervical carcinoma (28.71%); endometrial carcinoma (16.11%). Only 6 transvaginal surgeries (0.88%) had severe bleeding. The most common site of bleeding was massive oozing from the raw wound surface, then the paracervical area (15.7%), around sacral ligament (12.14%).
Conclusions: Advanced malignant tumors, tumors located at retroperitoneal or with extensive adhesion were the main causes of profuse bleeding during operation. Good surgical skill and well understanding of the pelvic anatomy are the basic key points for surgeons, and a supportive anesthesia is also important in reducing hemorrhage during operations. Once bleeding occurs, to stop the bleeding accurately and promptly by pressing, clamping, and suturing, and internal iliac artery ligation may be needed occasionally. Special attention should be paid to the hemostasis of the venous plexus of pelvic floor.