Postpartum Hemorrhage: Conservative Treatments

Abstract

Postpartum hemorrhage (PPH) is an obstetric emergency representing the first cause of obstetric mortality and a frequent cause of severe maternal morbidity. It can complicate vaginal or cesarean deliveries and accounts for 25% of all maternal deaths worldwide, as reported by the World Health Organization (WHO). Primary PPH is defined as blood loss from the genital tract of at least 500 ml after vaginal or 1000 ml following cesarean delivery within 24 h postpartum, whereas secondary PPH is defined as any significant bleeding from the birth canal occurring between 24 h and 12 weeks postnatally. Uterine atony is reported as the main cause of PPH and accounts for 75%–90% of primary PPH. When uterine atony is perceived to be a cause of the bleeding, then a combination of pharmacological, mechanical, and surgical methods should be applied until the bleeding stops. First-line conservative procedures for this condition are represented by bimanual uterine compression, medical therapy with uterotonic agents, uterine tamponade, and arterial embolization. If initial interventions fail to control PPH, treatment should progress to surgical options, such as uterine compression sutures, arterial ligation, or selective embolization of pelvic arteries. Conservative surgical interventions should be attempted initially if possible, but if unsuccessful, the decision must be made to proceed with hysterectomy.