Evaluation of Patients with Postpartum Hemorrhage Patients in a University-Affiliated Tertiary Care Hospital

Abstract

Abs tractAim: To retrospectively evaluate patients with postpartum hemorrhage (PPH) and to report the incidence, indication, and complications of PPH-related hysterectomies.Methods:We evaluated medical records of patients who received the diagnosis of in a university-affiliated tertiary care hospital between February 2013 and September 2014.Results:A total of 1724 deliveries were included in the study. 36 deliveries (2.08%) were complicated with PPH. PPH was found to result from the following conditions; uterine atony (n=19), placenta previa (n=8), vaginal lacerations (n=7), and coagulation disorders (n=2). A total of 7 patients (19.4%) with PPH, of whom two had uterine atony and five had placenta previa, underwent hysterectomy (4.06 per 1000 births). Application of B-Lynch uterine compression suturing and hypogastric artery ligation did not stop PPH in two patients with atony after primary caesarean section. Balloon tamponade was successful in 71.4% of patients with placenta previa. The most common complication among hysterectomy patients was admission to intensive care unit. Conclusion:Despite the improvements in conservative management strategies, our hysterectomy rate was higher than the reported literature. We conclude that management options should be individualized according to diagnosis, hemodynamic stability of patients and also facilities of the medical centre.

Secondary Postpartum Haemorrhage following vaginal delivery — a 3-year survey of causes and management

“…This difference may be related to our study criteria, which included only vaginal deliveries, and to geographical variation and to the lack of other available facilities for controlling postpartum haemorrhage; such as embolization, an alternative to a hysterectomy, is not available in our radiological department. In this study, endometritis was the leading cause of secondary PPH among the patients (64%), followed by retained placental pieces (13.5%), which is not consistent with Kasap et al [21] who did a retrospective descriptive study in North India for 6 months and found that retained products of contraception (RPOCs) was the leading cause (72% of patients) followed by endometritis (20%) [21]. This difference between our study and the other study might be due to a difference in sample size and our work included only women who delivered vaginally [22].…”

A Prospective Study To Evaluate The Etiology & Continuum of Management Protocol of Postpartum Haemorrhage

“…Burcu et al showed in their study that Balloon tamponade was successful in 71.4%. 22 Success rate of bilateral uterine artery ligation (BIIAL) in present study was 81.81% compared to study of Kabadi YM which had efficacy of BIIAL 86.7%. 23 A study by Kaya et al showed that overall success rate of B-lynch was 75% and the overall success rate of B-lynch plus BIIAL was 94.4%.…”

“…Burcu et al stated that first line conservative treatment modalities such as utreotonics and fundal massage were successful in 73.6% uterine atony patients. 22 As balloon tamponade was the least invasive and most rapid approach, it would be logical to use this as the first step in the management. In present study Balloon tamponade was successful in 68% cases and 32% cases followed by another method.…”

The effectiveness of using uterine tampons in treating uterine atony

“…Based on the time, PPP is divided into primary and secondary. Primary postpartum hemorrhage occurs within 24 hours after birth, while those that occur after 24 hours to 12 weeks after birth are called secondary PPH (Kasap et al, 2016). Primary postpartum hemorrhage consists of uterine atony, genital tract laceration, retained placenta, uterine inversion, abnormal placenta, and coagulation disorders.…”