Features of intensive organ-sparing therapy for massive postpartum hemorrhage

Abstract

Bleeding in pregnancy, childbirth and the postpartum period is one of the leading causes of maternal morbidity and mortality worldwide. There is no doubt that obstetric bleeding demands the development of improved methods for its diagnostics and treatment. We assessed the effectiveness of the treatment strategy for massive postpartum hemorrhage (PPH) with preservation of reproductive function, applied in the Perinatal Center of Irkutsk. We performed a retrospective analysis of 24 delivery cases, complicated by massive bleeding and successfully treated with preservation of reproductive organs. The massive nature of bleeding (> 30 % of blood volume) was registered in 15 (62.5 %) cases, mild (> 20 % but <30 % of blood volume) - in 9 (37.5 %). Emergency operative delivery (cesarean section) was performed in 40 % of massive PPH cases and in 66.7 % of mild PPH cases. Uterotonic drugs were used in all PPH cases. When analyzing complex mechanical methods of PPH arrest, we noticed that in 20 % of cases balloon tamponade was used. In 33.3 % of mild PPH cases, balloon tamponade with great vessels ligation was performed. Thus, the most effective method was balloon tamponade coupled with Baksheev forceps and early surgical hemostasis. All in all, prevention of hemorrhage in risk groups and early fluid and surgical therapy, and also administration of uterotonic drugs in PPH treatment not only provide a hemostatic effect but also preserve reproductive function.