[Surgical management of primary postpartum hemorrhage]

Despite the development of medical, obstetrical and arterial embolization techniques to control acute postpartum hemorrhage, familiarity with surgical procedures is essential. They may be the ultimate available option in order to obtain hemostasis. Conservative techniques consist of arterial ligations and uterine compression sutures that preserve the reproductive future and may be combined together. Radical options include hysterectomy which may be total or sub-total. To date, there are no comparative trials assessing the superiority of a given surgical option. In this review, the main surgical interventions are described and a practical stepwise approach is discussed according to the etiology, based on a professional consensus work-shop. Surgical management must be timely triggered after failure of first line treatments and integrated in a global strategy aimed to cease hemorrhage. It should be adapted to the available local health resources and in compliance with the various members of the medical staff.