Operative interventions in the management of major postpartum haemorrhage

Abstract

In many recent studies in the developed world, the incidence of postpartum haemorrhage (PPH) has been rising, though the mortality has come down, suggesting improvement in the management of this condition. Since the publication of the RCOG guidelines in 2009 for management of PPH and the Sheffi eld guidelines for the use of Rusch balloon along with the initial small case series (Keriakos and Mukhopadhyay 2006), many units have introduced the guidelines into clinical practice. This has led to the reduction of surgical intervention in our unit. Major PPH accounted for 1.6% of the total deliveries in our hospital. Surgical interventions accounted for 7.8% of these cases and only 0.1% of the total deliveries. Risk factors for PPH were identifi ed in 83%. In this paper, we reviewed the management of all patients who had major PPH and failed medical management over a period of about 4 years. All surgical interventions including Rusch balloon, B-Lynch suture, radiological interventions and hysterectomy were described. An update to Rusch balloon guidelines and Sheffi eld guidelines for management of major PPH are appended.

Postpartum hemorrhage at Yaoundé University Hospital, Cameroon

“…After adjusting for confounding factors, several independent risk factors for PPH were identified: history of uterine fibroids (adjusted odds ratio [aOR] 6.29; 95% CI, 1.6-25.3; P b 0.01); history of cesarean delivery (aOR 2.31; 95% CI, 1.2-4.3; P b 0.01); parity of 4 and above (aOR 2.03; 95% CI, 1.3-3.2, P b 0.01); prolonged labor (aOR 1.74; 95% CI,1.1-2.8; P = 0.01); twin delivery (aOR 3.18; 95% CI,1.7-5.8; P b 0.01); and fever during labor (aOR 4.89; 95% CI, 1.3-18.5); P b 0.01) ( Table 2). Similar risk factors were reported by other authors [3,4].…”

“…Of 10 302 births recorded, there were 419 (4.1%) cases of PPH. This prevalence is similar to that reported by others [3]. The etiology of PPH included atony (49.9%), retained placenta (39.2%), vaginal and perineal tear (6.9%), cervical tear (5.5%), uterine rupture (1.5%), placenta accreta (1.2%), stillbirth (1.2%), and endometritis (0.9%).…”

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Postpartum hemorrhage (PPH) is one of the leading causes of pregnancy-related mortality, accounting for up to 38% of maternal deaths [1,2]. The case fatality rate ranges from 1%-5% in many studies [1][2][3].A retrospective cross-sectional study was conducted at the University Hospital Center, Yaoundé, Cameroon after receiving Ethical Committee approval. The files of patients seen between January 1, 2005 and December 31, 2009 were included in the study and reviewed.

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“…Postpartum hemorrhage (PPH) is one of the leading causes of pregnancy-related mortality, accounting for up to 38% of maternal deaths [1,2]. The case fatality rate ranges from 1%-5% in many studies [1][2][3].…”

Obstetric Haemorrhage

“…Although some of these treatment options have been available for some years, the recognition of complications following their deployment is now accruing and needs including in any discussion with a patient before proceeding. Keriakos & Chaudhuri (2012) have reported their experience in Sheffi eld of 40 surgical interventions for major obstetric haemorrhage with 30,466 deliveries over 4 years; major PPH complicated 1.6% of these deliveries and surgical intervention was necessary in 7.8% of these PPHs or 0.1% of the total deliveries. Th ese surgical interventions include 31 cases where Rusch balloons were used for tamponade, eight insertions of B-Lynch sutures, and eight cases that ultimately required hysterectomy.…”