Possibility of reserving uterus during severe postpartum hemorrhage

Abstract

Objective To investigate the possibility of reserving uterus during severe postpartum hemorrhage. Methods A retrospective analysis was conducted on the clinical data of 138 cases of severe postpartum hemorrhage (blood loss ≥2000 ml) from January 1, 2003 to December 31, 2009. Results Among 138 cases of severe postpartum hemorrhage, uterine atony (n= 60, 43. 38 ％ ) was the first cause and the second was placental factor (n= 55, 39.86 ％). The blood loss varied from 2000 ml to 10 000 ml and the mean level was about (3004± 1473) ml. The volume of blood transfusion for these patients varied from 800 ml to 7200 ml. Among these patients, the blood loss of 108 cases reserved uteri was from 2000 ml to 7500 ml, with the average of (2564±932) ml； while for 30 cases performed with hysterectomy, the blood loss was about 2500 to 10 000 ml averagly (4653± 1857) ml (t=8. 57, P=0.00). These patients were divided into two groups according to time series. Twelve cases of hysterectomy were performed during 2003to 2005, and the hysterectomy rate was 0. 47‰; 18 cases of hysterectomy were performed during 2006 to 2009, and the hysterectomy rate was 0. 36‰. The average blood loss of the above two groups was (3783±861) ml and (5233±2124) ml respectively (t=2. 234, P=0. 034). Among all the cases with blood loss ≥ 3000 ml, uteri were reserved in 24 cases with the average blood loss of (3818 ± 1284) ml； while hysterectomy were performed in 27 cases with average blood loss of (4900 ± 1789) rnl (t = 2. 453, P =0. 018). The time for blood loss to 3000 ml in the two groups was (160±129) min and (100±67) min,respectively, and the difference was significant (t=2. 113, P = 0.04). The uteri of six cases with postpartum hemorrhage over 4000 ml were successfully reserved, and average bleeding amount was 5570 ml.Two patients among the 138 women died of amniotic fluid embolism. The perinatal mortality rate was 3. 73％. Conclusions The postpartum hemorrhage volume and velocity is the key point to decide whether to reserve the uterus or not. For the population with high risk factors, prophylaxis treatment with prostaglandins should be initiated to reduce the bleeding volume. Uterine packing might be an effective treatment to stop postpartum hemorrhage, especially for those bleeding due to placenta previa. Key words: Postpartum hemorrhage; Embolization,therapeutic; Prostaglandins