ABSTRACT
Bleeding from broad tissue planes is common. A general ooze should not be ignored and may result in significant blood loss, delayed primary haemorrhage or haematoma formation.
ACTION PLAN
1Small bleeding points on the vaginal mucosa, bladder and rectal muscle should be clamped and either tied or ligated
2Bleeding from the vessels of the urogenital diaphram can be difficult to expose but can usually be controlled with figure-of-8 sutures
3Pedicles at vaginal hysterectomy should be carefully ligated as slip page can result in a large primary haemorrhage. Transfixing
thepedicles makes them less likely to slip 4Traction should not be applied to sutures on vascular pedicles 5Good access, retraction, light suction and capable assistance are essential 6Laparotomy will be required if the bleeding point cannot be secured
vaginally
Delayed primary haemorrhage (reactionary)
Persistence of fresh bleeding (through the pack and onto the bed!), particularly within the first 3 hours after surgery strongly suggests that haemostasis has not been secured!
