The outcomes of surgical treatment modalities to decrease “near miss” maternal morbidity caused by peripartum hemorrhage

N. Danisman, S. Kahyaoglu, S. Celen, B. Akselim, E.G. Tuncer, H. Timur, O. Kaymak, I. Kahyaoglu

Department of High Risk Pregnancies, Zekai Tahir Burak Women’s Health and Research Hospital, Ankara, Turkey. mdserkankahyaoglu@gmail.com

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• Obstetrics

BACKGROUND: The treatment of patients with peripartum hemorrhage is unfortunately characterized by inadequate treatment that does not adhere to standard therapeutic measures.

AIM: Assessment of different management strategies among patients with severe hemorrhage, particularly the ones with “near-miss” maternal morbidity and mortality to establish clinically useful guidelines for the prevention and management of peripartum hemorrhage.

PATIENTS AND METHODS: In this study, the medical records of 458 patients who have experienced peripartum hemorrhage between March 2009 and March 2012 in a tertiary perinatal center were retrospectively reviewed. Specific surgical treatment modalities utilized to 61 patients with severe peripartum hemorrhage with respect to the procedure timing and effectivity were compared according to the outcomes and efficiency.

RESULTS: Sixty-one patients who have been diagnosed as severe peripartum hemorrhage have been included to the study. Six (75%) of the 8 patients who were treated with B-Lynch brace suture for uterine atony and 9 (60%) of the 15 patients who were treated with the Bakri balloon tamponade system for uterine atony or placenta accreta required hysterectomy following the initial therapeutic measures. The patients who have been treated with bilateral hypogastric artery ligation and B-Lynch brace suture or Bakri balloon uterine tamponade system were less likely to need a complementary hysterectomy for definitive treatment of peripartum hemorrhage when compared with patients treated with either B-Lynch brace suture or Bakri uterine tamponade balloon system alone.

CONCLUSIONS: The efficiency of B-Lynch compression brace sutures and the Bakri balloon uterine tamponade system is unpredictable in terms of the need for hysterectomy for peripartum hemorrhage patients diagnosed as either uterine atony or placenta previa. Regardless of the initial diagnosis, these modalities seem to be more effective in alleviating peripartum hemorrhage when accompanied by hypogastric artery ligation.

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