Postpartum hemorrhage (PPH) remains a major worldwide cause of maternal morbidity and mortality. Second-line interventions including uterine tamponade, dilation and curettage, uterine artery embolization (UAE), compression or hemostatic sutures, or hysterectomy, are often required to manage severe PPH. Our study sought to evaluate the success rates and complications of second-line therapies used to treat stage 3 PPH, defined as an estimated blood loss of greater than 1500 mL by the California Maternal Quality Care Collaborative.METHODS:
This retrospective cohort study examined all deliveries at a tertiary care center between 2007 and 2015 complicated by a stage 3 primary PPH. The timing, order, and success rates of interventions performed and the subsequent complications were evaluated. Complications examined included ICU admission, hemorrhagic shock, disseminated intravascular coagulopathy (DIC), and endometritis.RESULTS:
Of 21,067 deliveries, 267 (1.26%) were complicated by stage 3 PPH. Second-line therapies were used in 116/267 (44%). The highest success rates were found with UAE (94%, n=18), compression sutures (73%, n=29) and balloon tamponade (72%, n=68). Patients undergoing dilation and curettage as an initial second-line management were most likely to require additional intervention (54%). Endometritis and DIC were the most common complications (8%). Endometritis was most common after successful treatment with compression sutures (29%). The use of multiple interventions was associated with a higher incidence of complications.CONCLUSION:
For the treatment of severe PPH, the use of uterine tamponade and UAE have high success rates and low complication rates. Our results can help inform management of stage 3 PPH, as it is less standardized.