"4Ts Plus Model"/ PPH's New Chapter : Lower uterine segment bleeding : overlooked etiology of postpartum hemorrhage
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Abstract
Background : Post-partum hemorrhage (PPH) is a fatal postpartum complication dreaded by every obstetrician. Despite advances made in the past century in regards of prevention and treatment of PPHs, the prevalence of atonic PPH paradoxically increased during the past couple decades, developed countries included. Studies revealed that lower uterine segment atony or LUSA could lead to PPH via mechanism of uterine hypoxia. In order to tackle the problem at its root, lower uterine segment compression (LUSC) could be deployed to prevent LUSA and subsequently PPH.
Contemporary mnemonics of 4Ts remind us of possible etiologies of PPH. Nevertheless, it did not encompass the entirety of the various causes. The author proposed an innovative model, aptly named “4Ts Plus Model”, where atony would be further distinguished into flaccid uterine atony and hypoxic uterine atony. The incidence of the latter could be prevented up to 56.5 – 81.3% by LUSC, depending on the compression duration.
Conclusion : With the discovery of LUSA being another cause of PPH, the new 4Ts Plus Model and LUSC offer innovative strategies for treatment of patients with PPHs which could ultimately lead to lower global maternal postpartum mortalities.
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