Surgical Management of Postpartum Haemorrhage: Analysis of 14 Cases

Abstract

OBJECTIVE: The aim of this study was to present our experience with surgical management of postpartum haemorrhage (PPH).
STUDY DESIGN: Data of 14 cases with surgically managed PPH were retrospectively analyzed. Maternal characteristics, the indication for surgery, estimated blood loss, postoperative complications were recorded.
RESULTS: During the study period there were six postpartum hysterectomies, three hysterectomies together with internal iliac artery ligation (IIAL) and five women had IIAL in our unit. The incidence of peripartum hysterectomy due to PPH was 0.40/1000 deliveries and the incidence of IIAL due to PPH was 0.53/1000 deliveries. Three out of eight women where IIAL was performed also required hysterectomy
to arrest bleeding, giving an overall uterine preservation rate of 62.5%. The main indications for postpartum hysterectomy and/or IIAL were uterine atony in 12 cases (85 %) and uterine rupture in two cases (15 %). Mean estimated blood loss was 2732.1±1080.5 mL (range 1200-4500). There was one maternal death (%7) due to hypovolemic shock during postpartum hysterectomy for uterine atony.
CONCLUSION: Uterine atony is the main indication for postpartum hysterectomy and/or IIAL. IIAL is an effective procedure to control PPH. In failed cases, emergency obstetric hysterectomy remains an essential life-saving procedure.