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

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.