Skip to main content
SpringerLink
Log in

Conservative Surgical Management of Early Postpartum Hemorrhage: A 12-Year Experience in a Tertiary Care Center in the South of Thailand

  • Original Article
  • Published:
The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Background/Purpose of the Study

To evaluate the success rate and predictive factors of success in conservative surgical management of early postpartum hemorrhage (PPH).

Methods

A retrospective study was conducted at a tertiary care hospital in the south of Thailand, from January 2006 to December 2017. PPH with conservative surgical management including Bakri balloon tamponade, B-Lynch uterine compression sutures, arterial embolization, vessel ligations, and combined surgical procedures was reviewed. The procedures were considered successful if bleeding could be controlled without subsequent hysterectomy. Multivariate logistic regression analysis was used to identify predictive factors for success of conservative surgical treatment.

Results

Among 39,327 deliveries, 1461 (3.7%) patients had early PPH, and 92 cases received conservative surgical management. Most patients (92.4%) underwent cesarean section. Median (IQR) blood loss before conservative surgery was 1800 (1100, 2575) mL, and median (IQR) time from early PPH to conservative surgical management was 41 (25.5, 60.0) minutes. The overall success rate of conservative surgical management was 80.4%, meanwhile the postoperative complication rate was 27.2%. The predictive factors significantly associated with success were maternal age < 35 years (odds ratio [OR] 4.53, 95% confidence interval [CI] 1.27–16.23; p = 0.02), blood loss before conservative surgery < 1800 mL (OR 5.82, 95% CI 1.45–23.33; p = 0.01), and time to start conservative surgery ≤ 40 min (OR 4.76, 95% CI 1.13–20.12; p = 0.03).

Conclusion

The overall success rate of conservative surgical procedures was high. Maternal age < 35 years, blood loss before conservative management < 1800 mL, and time to conservative surgery ≤ 40 min were predictive factors of success.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sheldon WR, Blum J, Vogel JP, et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization multicountry survey on maternal and newborn health. BJOG. 2014;121(Suppl 1):5–13.

    Article  Google Scholar 

  2. Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066–74.

    Article  Google Scholar 

  3. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33.

    Article  Google Scholar 

  4. Practice Bulletin No.183: Postpartum Hemorrhage. Obstet Gynecol. 2017;130(4):e168–86.

  5. Kramer MS, Berg C, Abenhaim H, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209(5):449.e1-449.e7.

    Article  Google Scholar 

  6. Al-Zirqi I, Vangen S, Forsen L, et al. Prevalence and risk factors of severe obstetric haemorrhage. BJOG. 2008;115(10):1265–72.

    Article  CAS  Google Scholar 

  7. Edwards HM. Aetiology and treatment of severe postpartum haemorrhage. Dan Med J. 2018;65(3):B5444.

    PubMed  Google Scholar 

  8. Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv. 2007;62(8):540–7.

    Article  Google Scholar 

  9. Kayem G, Kurinczuk JJ, Alfirevic Z, et al. Uterine compression sutures for the management of severe postpartum hemorrhage. Obstet Gynecol. 2011;117(1):14–20.

    Article  Google Scholar 

  10. Sentilhes L, Gromez A, Clavier E, et al. Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage. Obstet Gynecol. 2009;113(5):992–9.

    Article  Google Scholar 

  11. Knight M, Kurinczuk JJ, Spark P, et al. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol. 2008;111(1):97–105.

    Article  Google Scholar 

  12. Yamasaki Y, Morita H, Miyahara Y, et al. The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage. J Perinat Med. 2014;42(3):359–62.

    Article  Google Scholar 

  13. Puangsricharoen P, Manchana T. Conservative surgical management for immediate postpartum hemorrhage. Asian Biomed. 2019;13(3):107–11.

    Article  Google Scholar 

  14. Kaoiean S. Successful use of the B-Lynch uterine compression suture in treating intractable postpartum hemorrhage after cesarean delivery in Rajavithi Hospital. J Med Assoc Thai. 2013;96(11):1408–15.

    PubMed  Google Scholar 

  15. Tindell K, Garfinkel R, Abu-Haydar E, et al. Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: a systematic review. BJOG. 2013;120(1):5–14.

    Article  CAS  Google Scholar 

  16. Sentilhes L, Trichot C, Resch B, et al. Fertility and pregnancy outcomes following uterine devascularization for severe postpartum haemorrhage. Hum Reprod. 2008;23(5):1087–92.

    Article  Google Scholar 

  17. Sathe NA, Likis FE, Young JL, et al. Procedures and Uterine-Sparing Surgeries for Managing Postpartum Hemorrhage: A systematic Review. Obstet Gynecol Surv. 2016;71(2):99–113.

    Article  Google Scholar 

  18. El-Hamamy E, B-Lynch C. A worldwide review of the uses of the uterine compression suture techniques as alternative to hysterectomy in the management of severe post-partum haemorrhage. J Obstet Gynaecol. 2005;25(2):143–9.

  19. Sentilhes L, Merlot B, Madar H, et al. Postpartum haemorrhage: prevention and treatment. Expert Rev Hematol. 2016;9(11):1043–61.

    Article  CAS  Google Scholar 

  20. Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52. BJOG. 2017;124(5):e106–49.

  21. O’Leary JA. Uterine artery ligation in the control of postcesarean hemorrhage. J Reprod Med. 1995;40(3):189–93.

    PubMed  Google Scholar 

  22. Joshi VM, Otiv SR, Majumder R, et al. Internal iliac artery ligation for arresting postpartum haemorrhage. BJOG. 2007;114(3):356–61.

    Article  CAS  Google Scholar 

  23. Kaya B, Damarer Z, Daglar K, et al. Is there yet a role for internal iliac artery ligation in obstetric hemorrhage with the current again in popularity of other uterus sparing techniques? J Matern Fetal Neonatal Med. 2017;30(11):1325–32.

    Article  Google Scholar 

  24. Revert M, Cottenet J, Raynal P, et al. Intrauterine balloon tamponade for management of severe postpartum haemorrhage in a perinatal network: a prospective cohort study. BJOG. 2017;124(8):1255–62.

    Article  CAS  Google Scholar 

  25. Grange J, Chatellier M, Chevé M, et al. Predictors of failed intrauterine balloon tamponaded for persistent postpartum hemorrhage after vaginal delivery. PLoS One. 2018;13(10):e0206663.

  26. Kong CW, To WW. Prognostic factors for the use of intrauterine balloon tamponade in the management of severe postpartum hemorrhage. Int J Gynaecol Obstet. 2018;142(1):48–53.

    Article  Google Scholar 

Download references

Funding

No funding has been received.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand

    Satit Klangsin, Pichaya Booncharoen & Chitkasaem Suwanrath

Authors
  1. Satit Klangsin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pichaya Booncharoen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chitkasaem Suwanrath
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have contributed to the design, data collection, data analysis, writing, and proofreading of manuscript.

Corresponding author

Correspondence to Satit Klangsin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standards

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board of the Faculty of Medicine, Prince of Songkla University approved this study.

Ethical Statement

Ethical clearance was obtained from the Institutional Review Board of the Faculty of Medicine, Prince of Songkla University (REC. 61-052-12-4).

Informed Consent

Informed consent was obtained from all individual participants involved in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Satit Klangsin is a Lecturer, Obstetrician and Gynecologist. Pichaya Booncharoen is an Obstetrician and Gynecologist. Chitkasaem Suwanrath is an Assoc. Prof., Obstetrician and Gynecologist.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Klangsin, S., Booncharoen, P. & Suwanrath, C. Conservative Surgical Management of Early Postpartum Hemorrhage: A 12-Year Experience in a Tertiary Care Center in the South of Thailand. J Obstet Gynecol India 72 (Suppl 1), 180–185 (2022). https://doi.org/10.1007/s13224-022-01628-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-022-01628-9

Keywords

Search

Navigation