Surgical aspects of postpartum haemorrhage

Postpartum haemorrhage (PPH) refers to excessive bleeding from the genital tract after birth. Failure of medical treatment to control bleeding would necessitate surgical measures to arrest haemorrhage, to save lives. Algorithms such as HAEMOSTASIS have been proposed as aids to the systematic and stepwise management of primary PPH. Clinicians need to be aware of various surgical techniques that could be employed to arrest haemorrhage, the appropriateness of a chosen surgical intervention to the specific clinical situation and the timing of instituting the intervention. Surgical measures to arrest PPH include repair of genital tract trauma, evacuation of retained products of conception, uterine balloon tamponade, exploratory laparotomy and uterine compression sutures, systematic pelvic devascularization, uterine artery embolization, subtotal and total abdominal hysterectomy. Consideration should also be given to the experience and the skill of the operator, as well as to the familiarity with the chosen surgical procedure.