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Outcome of the management of massive postpartum hemorrhage using the algorithm “HEMOSTASIS”
Author(s) -
Varatharajan Lavanya,
Chandraharan Edwin,
Sutton Julian,
Lowe Virginia,
Arulkumaran Sabaratnam
Publication year - 2011
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2010.11.021
Subject(s) - medicine , hemostasis , hysterectomy , uterotonic , surgery , tamponade , balloon tamponade , retrospective cohort study , obstetrics , blood transfusion , oxytocin
Objective To evaluate whether the algorithm “HEMOSTASIS” ( h elp; e stablish etiology; m assage the uterus; o xytocin infusion and prostaglandins; s hift to operating theater; t amponade test; a pply compression sutures; s ystematic pelvic devascularization; i nterventional radiology; s ubtotal/total abdominal hysterectomy) was of value in the systematic management of postpartum hemorrhage (PPH). Methods A retrospective analysis was performed of all women who experienced massive primary PPH (blood loss > 1500 mL) 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. Results 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. Conclusion 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.