Outcome of the management of massive postpartum hemorrhage using the algorithm "HEMOSTASIS"

To evaluate whether the algorithm "HEMOSTASIS" (help; establish etiology; massage the uterus; oxytocin infusion and prostaglandins; shift to operating theater; tamponade test; apply compression sutures; systematic pelvic devascularization; interventional radiology; subtotal/total abdominal hysterectomy) was of value in the systematic management of postpartum hemorrhage (PPH).

A retrospective analysis was performed of all women who experienced massive primary PPH (blood loss >1500mL) in 2008 at St George's Hospital, London, UK. The success of the HEMOSTASIS mnemonic in PPH management was determined by assessing clinical outcome following adherence to the protocol.

Patient notes were available for 95 (83.3%) of the 114 cases of primary PPH. Hemostasis was achieved in 63 (66.3%) women via use of additional oxytocics ("O"); 19 (20.0%) via suture of tears and 10 (10.5%) via tamponade ("T"); 1 (1.1%) via application of compression suture ("A"); 1 (1.1%) via systematic devascularization ("S"); and 1 (1.1%) via subtotal/total hysterectomy ("S"). There were no maternal deaths.

The decremental pattern of more complex interventions used demonstrates that the algorithm can provide a logical management pathway to reduce blood transfusions, hysterectomies, admissions to intensive care units, and maternal deaths.