J Korean Med Assoc.  2007 Dec;50(12):1096-1106. 10.5124/jkma.2007.50.12.1096.

Management of Postpartum Hemorrhage

• Kim A

• KMID: 2184958
• DOI: http://doi.org/10.5124/jkma.2007.50.12.1096

Abstract

Despite recent improvements in the intensive care for postpartum hemorrhage, it remains one of the leading causes of maternal mortality and morbidity for obstetricians. Because it is difficult to prevent or predict postpartum hemorrhage, it is important to manage any such patients correctly and promptly. Management of postpartum hemorrhage may vary greatly among patients, depending on the etiology of the bleeding, available treatment options, and the patient's desire for future fertility. When managing postpartum hemorrhage, it is necessary to balance the use of conservative management with the need to control the bleeding and achieve hemostasis. Uterine massage and compression, and the administration of uterotonics such as oxytocin, ergometrine, and prostaglandins are primary, conservative, and noninvasive management techniques for patients with postpartum hemorrhage. Relatively noninvasive procedures such as curettage of remnant tissues, vaginal packing, repair of laceration, and percutaneous angiographic embolization can also be performed. In cases where these management techniques fail, surgical alternatives such as uterine or internal iliac artery ligation, uterine compression sutures, or hystrectomy are used. Surgical treatment of postpartum bleeding, performed as an appropriate and timely intervention, is life-saving. The management of postpartum bleeding requires a multidisciplinary approach with timely and efficient communication between clinical specialists and preserving fertility.

Keyword

Postpartum hemorrhage; Medical management; Surgical management

MeSH Terms

Critical Care
Curettage
Ergonovine
Fertility
Hemorrhage
Hemostasis
Humans
Iliac Artery
Lacerations
Ligation
Massage
Maternal Mortality
Oxytocin
Postpartum Hemorrhage*
Postpartum Period*
Prostaglandins
Specialization
Sutures
Ergonovine
Oxytocin
Prostaglandins

Figure

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  Figure 1 Management of major postpartum hemorrhage (blood loss >1,000ml or clinical shock)(12).

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  Figure 2 A 31 year-old female delivered a baby by vaginal birth at local clinic. A) Arterial angiogram shows that a pseudoaneurysm (arrow) of left uterine artery. B) Gelfoam and glue (1:1 mixture with lipiodol) embolization with use of microcatheter. Vascularity of left uterine artery has disappered on postembolization left internal iliac angiogram.

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  Figure 3 Suture placement in the B-Lynch compression stitch for atonic uterine hemorrhage(4).

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