Single, double, and triple modalities of uterinesparing treatment for primary postpartum haemorrhage: a 14-year retrospective cohort study

Authors

  • LT KWONG
  • PL SO
  • SF WONG

DOI:

https://doi.org/10.12809/hkjgom.21.1.01

Keywords:

Hemostasis, Hysterectomy, Postpartum hemorrhage, Uterine haemorrhage

Abstract

Introduction: To evaluate the success rate and short-term complications of single, double, and triple modalities of uterine-sparing treatment (UST) for primary postpartum haemorrhage (PPH).
Methods: We retrospectively reviewed records of women who underwent UST for PPH between 2006 and 2019 in Tuen Mun Hospital. The success rates of single, double, and triple modalities of UST (derived from the number of haemostatic hysterectomies prevented) were compared, as were short-term complications between single and double modality groups.
Results: Of 221 women who underwent UST for primary PPH, 174 (78.7%) received single, 44 (19.9%) received double, and 3 (1.4%) received triple modalities of UST. The three groups were comparable, except that there were more nulliparous women in the double than single modality group, more women having caesarean sections in the single than double or triple modality group, and more uterine atony in the double or triple than single modality group. The success rate of haemostasis decreased from 94.3% after single modality to 90.9% after double modalities to 0% after triple modalities (p<0.001). All three women with triple modalities of UST eventually underwent haemostatic hysterectomy. The single and double modality groups were comparable in terms of short-term complications.
Conclusion: Single and double modalities of UST were effective and safe in treating primary PPH. Early resort to hysterectomy should be considered if double modalities of UST failed to achieve haemostasis.

References

Mousa HA, Walkinshaw S. Major postpartum haemorrhage. Curr Opin Obstet Gynecol 2001;13:595-603.

WHO Guidelines for the Management of Postpartum Haemorrhage and Retained Placenta. Geneva: World Health Organization; 2009.

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;62:540-7.

Doumouchtsis SK, Nikolopoulos K, Talaulikar V, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: a systematic review. BJOG 2014;121:382-8.

Kaya B, Tuten A, Daglar K, et al. B-Lynch uterine compression sutures in the conservative surgical management of uterine atony. Arch Gynecol Obstet 2015;291:1005-14.

Gottlieb AG, Pandipati S, Davis KM, Gibbs RS. Uterine necrosis: a complication of uterine compression sutures. Obstet Gynecol 2008;112:429-31.

Joshi VM, Shrivastava M. Partial ischemic necrosis of the uterus following a uterine brace compression suture. BJOG 2004;111:279-80.

Treloar EJ, Anderson RS, Andrews HS, Bailey JL. Uterine necrosis following B-Lynch suture for primary postpartum haemorrhage. BJOG 2006;113:486-8.

Cottier JP, Fignon A, Tranquart F, Herbreteau D. Uterine necrosis after arterial embolization for postpartum hemorrhage. Obstet Gynecol 2002;100:1074-7.

Benkirane S, Saadi H, Serji B, Mimouni A. Uterine necrosis following a combination of uterine compression sutures and vascular ligation during a postpartum hemorrhage: a case report. Int J Surg Case Rep 2017;38:5-7.

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 2006;108:1039-47.

Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296-327.

Firmin M, Carles G, Mence B, Madhusudan N, Faurous E, Jolivet A. Postpartum hemorrhage: incidence, risk factors, and causes in Western French Guiana. J Gynecol Obstet Hum Reprod 2019;48:55-60.

Sentilhes L, Gromez A, Razzouk K, Resch B, Verspyck E, Marpeau L. B-Lynch suture for massive persistent postpartum hemorrhage following stepwise uterine devascularization. Acta Obstet Gynecol Scand 2008;87:1020-6.

Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG 2010;117:84-93.

Dohbit JS, Foumane P, Nkwabong E, et al. Uterus preserving surgery versus hysterectomy in the treatment of refractory postpartum haemorrhage in two tertiary maternity units in Cameroon: a cohort analysis of perioperative outcomes. BMC Pregnancy Childbirth 2017;17:158.

Dadhwal V, Sumana G, Mittal S. Hematometra following uterine compression sutures. Int J Gynaecol Obstet 2007;99:255-6.

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Published

2023-04-06

How to Cite

1.
KWONG L, SO P, WONG S. Single, double, and triple modalities of uterinesparing treatment for primary postpartum haemorrhage: a 14-year retrospective cohort study. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2023 Apr. 6 [cited 2024 Mar. 29];21(1). Available from: https://hkjgom.org/home/article/view/290

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