MANAGEMENT OF PELVIC HEMORRHAGE

Massive pelvic hemorrhage is a potential complication in any patient undergoing obstetric or gynecologic surgery. Intraoperative, postoperative, or postpartum hemorrhage occurs predominantly as a result of unexpected vascular injury and inability to control excessive bleeding during a surgical procedure. Knowledge of the anatomic distribution of the blood supply to the pelvis and the coagulation system, with its intrinsic and extrinsic pathways, is essential in implementing appropriate preventive measures. Immediate recognition and prompt action at the occurrence of pelvic hemorrhage can significantly minimize life-threatening complications. This article reviews the management of pelvic hemorrhage in obstetrics and gynecology, briefly discussing the blood supply to the pelvis and the physiology of normal coagulation and focusing on the causes and treatment of specific vascular injuries incurred during pelvic surgery.