Conservative surgical management for immediate postpartum hemorrhage

Background: Conservative surgical management for postpartum hemorrhage (PPH), such as balloon tamponade, uterine compression suture, and uterine artery ligation, has the benefit of preserving reproductive function. Objectives: To assess the efficacy and subsequent pregnancy outcome of conservative surgical management for patients with immediate PPH. Methods: Medical records of patients who had PPH between January 2011 and December 2016 were reviewed. Conservative surgical management included B-Lynch uterine compression suture, Bakri balloon tamponade, and uterine artery ligation. The treatments were considered successful if patients did not require subsequent hysterectomy. Perioperative complications and subsequent pregnancy outcomes were recorded. Results: Of 30,271 deliveries, 669 patients experienced PPH or 2.2% of total deliveries. Sixty-one patients (9.1%) did not respond to medical treatment with various uterotonic agents. Hysterectomy was selected initially in 30 patients. Conservative surgical management was performed in 31 patients: 15 Bakri balloon tamponade, 13 uterine compression suture, and 3 uterine artery ligation. There were 3 patients who failed Bakri balloon tamponade and proceeded to perform uterine compression suture with successful outcome. The success rates for conservative surgical treatment were 66.7%, 75%, and 66.7%, respectively. All patients who had successful conservative surgical management resumed normal menstruation. Three out of 11 patients (27.3%) who desired subsequent pregnancy were able to conceive and carry out a viable pregnancy. Conclusion: Conservative surgical management has acceptable success rates for controlling intractable immediate PPH. Implementation of such procedures should be done to preserve fertility and decrease maternal morbidity and mortality.