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Outcomes and prognosis of postpartum hemorrhage according to management protocol: an 11-year retrospective study from
Ye Won Jung1,2, Jin Kim3, Won Kyo Shin1
1Department of Obstetrics & Gynecology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea.
Insights
Surgical intervention for postpartum hemorrhage (PPH) is indicated for patients with higher lactic acid and shock index levels. Immediate surgery may improve outcomes compared to delayed intervention for PPH caused by uterine atony.
Area of Science:
- Obstetrics and Gynecology
- Critical Care Medicine
- Surgical Outcomes Research
Background:
- Postpartum hemorrhage (PPH) lacks standardized treatment guidelines.
- This study compares surgical versus non-surgical management of PPH.
- Evaluating patient outcomes and prognoses is crucial for PPH management.
Purpose of the Study:
- To assess differences in outcomes and prognoses between surgical and non-surgical PPH treatments.
- To identify predictors for surgical intervention in PPH cases.
- To compare immediate versus delayed surgical interventions for PPH.
Main Methods:
- Retrospective study of 230 PPH patients (August 2013 - October 2023).
- Patients divided into non-surgical (n=159) and surgical (n=71) groups.
- Subgroup analysis of immediate (n=45) vs. delayed (n=26) surgical interventions.
Main Results:
- Surgical group (Group 2) showed higher initial lactic acid and shock index, and lower heart rate and body temperature.
- Predictors for surgery included low body temperature, high lactic acid, and high shock index.
- Surgical intervention was associated with poorer overall outcomes; delayed surgery increased risks of hysterectomy and coagulopathy.
Conclusions:
- Elevated lactic acid, shock index, and low body temperature may indicate need for surgical PPH intervention.
- Immediate surgical intervention for PPH, especially with uterine atony, may improve prognosis.
- Further research into optimal timing and indications for PPH surgery is warranted.
Background:
No standard treatment guidelines have been established for postpartum hemorrhage (PPH). We aimed to assess the differences in outcomes and prognoses between patients with PPH who underwent surgical and non-surgical treatment.
Methods:
This retrospective study included 230 patients diagnosed with PPH at two referral hospitals between August 2013 and October 2023. The patients were divided into non-surgical (group 1, n = 159) and surgical intervention groups (group 2, n = 71). A subgroup analysis was performed by dividing the surgical intervention group into immediate (n = 45) and delayed surgical intervention groups (n = 26).
Results:
Initial lactic acid levels and shock index were significantly higher in group 2 (2.85 ± 1.37 vs. 4.54 ± 3.63 mmol/L, p = 0.001, and 0.83 ± 0.26 vs. 1.10 ± 0.51, p < 0.001, respectively). Conversely, initial heart rate and body temperature were significantly lower in group 2 (92.5 ± 21.0 vs. 109.0 ± 28.1 beat/min, p < 0.001, and 37.3 ± 0.8 °C vs. 37.0 ± 0.9 °C, p = 0.011, respectively). Logistic regression analysis identified low initial body temperature, high lactic acid level, and shock index as independent predictors of surgical intervention (p = 0.029, p = 0.027, and p = 0.049, respectively). Regarding the causes of PPH, tone was significantly more prevalent in group 1 (57.2% vs. 35.2%, p = 0.002), whereas trauma was significantly more prevalent in group 2 (24.5% vs. 39.4%, p = 0.030). Group 2 had worse overall outcomes and prognoses than group 1. The subgroup analysis showed significantly higher rates of uterine atony combined with other causes, hysterectomy, and disseminated intravascular coagulopathy in the delayed surgical intervention group than the immediate surgical intervention group (42.2% vs. 69.2%, p = 0.027; 51.1% vs. 73.1%, p = 0.049; and 17.8% vs. 46.2%, p = 0.018, respectively).
Conclusions:
Patients with PPH presenting with increased lactic acid levels and shock index and decreased body temperature may be surgical candidates. Additionally, immediate surgical intervention in patients with uterine atony combined with other causes of PPH could improve prognosis and reduce postoperative complications.
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