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On Tuesday, the director of the Institute for Women's Health at University College London, Prof Peter Brocklehurst, said the charges against Dharmasena – the first ever for FGM in the UK – meant victims of FGM could be left bleeding after childbirth because there was "a lot of worry among midwives and obstetricians about what they can and can't do to control haemorrhaging".
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However, patients who underwent an emergent surgical or radiological procedure to control haemorrhage were identified and analysed.
Consequently, they suggested that the submental artery should be ligated first during extra-oral ligation to control haemorrhage in the floor of the mouth.
Forty-six patients (5%) with a normal i-Hb and who did not fulfil the criteria for haemodynamic instability underwent an emergent surgical or angiographic procedure to control haemorrhage.
We found that in none of the patients with a normal i-Hb, the r-Hb had clinical consequences, even in patients who underwent an emergent surgical or angiographic procedure to control haemorrhage.
The possibility of existence of anastomoses and the lack of consensus as to the source of the artery that enters the MMLF pose a dilemma of whether the submental or the lingual artery should be ligated first in the event an extra-oral approach is required to control haemorrhage [7].
Fibrinogen preparations have been used to control haemorrhage since 1948.
Initial abbreviated surgery with planned reoperation (damage control surgery) is frequently used for major trauma patients to rapidly control haemorrhage while limiting surgical stress.
In 1983, Stone and colleagues described the techniques of abbreviated laparotomy, packing to control haemorrhage and of deferred definitive surgical repair until coagulation has been established [ 156].
When uncontrolled arterial bleeding occurs from mangled extremity injuries, including penetrating or blast injuries or traumatic amputations, a tourniquet represents a simple and efficient method to acutely control haemorrhage [ 27- 31].
When used in the palliation of inoperable renal cell cancer, a number of case-reports and case-series exist in which embolisation has been used to control haemorrhage and provide relief from local and metastatic pain.
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