title: [Post-partum haemorrhage associated with genital tract lacerations: series of 44 cases].
abstract: OBJECTIVE
  Genital tract lacerations are responsible for potentially serious postpartum hemorrhage (PPH), and are often underestimated. The objective of this study was to analyze the characteristics of genital tract lacerations associated with severe PPH in a reference center.
  
  
  METHODS
  All women transferred for treatment of PPH due to genital tract lacerations between January 2008 and April 2011 were included in this observational study. Two populations of patients with genital tract lacerations were defined : patients with "complex" lesions and patients with "simple" genital tract laceration.
  
  
  RESULTS
  Forty-four patients were treated for PPH associated with genital tract lacerations. The average age of patients was 30.6 years (17-41 years). All the patients had a vaginal delivery, combined with an instrumental in 70.5% of cases. With the exception of one patient, all patients had a revision of the cervix and vagina before the transport in our Institution. Twenty nine patients (70.7%) had received a suture of genital tract in their maternity. In our Hospital, the patient having a "simple" genital tract lesion received in 54.5% of cases medical drugs alone against 33.3% for patients with complex genital tract lacerations. In 39.4% of cases an embolization was necessary for the group of patients with complex genital tract lacerations against 9.1% in the simple genital tract lesion group.
  
  
  CONCLUSIONS
  Genital tract lacerations are a serious cause of HDD. Their management should be multidisciplinary combining appropriate and timely decisions (resuscitation, embolization and/or surgery). The sequence of these treatments depends on the clinical condition of the patient and justifies a transfer to a referral center.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Lariboisière, GH Saint-Louis Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Maraux
authors.forename: A
authors.initials: A
authors.lastname: Ricbourg
authors.forename: C
authors.initials: C
authors.lastname: Brugier
authors.forename: S
authors.initials: S
authors.lastname: Chagnaud
authors.forename: Y
authors.initials: Y
authors.lastname: Fargeaudou
authors.forename: M
authors.initials: M
authors.lastname: Rossignol
authors.forename: E
authors.initials: E
authors.lastname: Barranger
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005836:Genitalia, Female / Q000293:injuries*; D006801:Humans; D022125:Lacerations / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Embolisation; Embolization; Genital tract lacerations; Hysterectomy; Hystérectomie d’hémostase; Hémorragie de la délivrance; Plaie de la filière génitale; Postpartum haemorrhage