ObjectiveTo explore the effectiveness of different hemostatic methods in the treatment of refractory postpartum hemorrhage, and the causes of hemostasis failure.
MethodsAmong 71 puerpera with refractory postpartum hemorrhage, 35 cases were treated with intrauterine gauze packing, 25 cases were treated with intrauterine vaginal balloon compression, and 11 cases were treated with uterine artery embolization.According to different hemostatic methods, 71 puerpera were divided into the gauze packing group (gauze group), balloon compression group (balloon group) and arterial embolization intervention group (interventional group). Accordingto the method of tamponade treatment (including gauze tamponade and balloon compression), the patients were divided into the tamponade treatment group (tamponade group), tamponade combined with interventional treatment group (tamponade+interventional group), and tamponade combined with hysterectomy group (tamponade+hysterectomy group).The intraoperative condition, postoperative fever and treatment among all groups were compared, and the causes of hemostatic failure were analyzed using multi-factor method.
ResultsThe postpartum blood loss in 71 cases was 1 100~8 000 mL, the successful hemostasis in 64 cases was found, and 7 cases were treated with hysterectomy after hemostasis.There was no statistical significance in intraoperative blood loss, postpartum 24 h blood loss, and transfusion of erythrocyte suspension and plasma among three groups with different hemostatic methods (P>0.05).The comparison results among three groups with different tamponade methods showed that the intraoperative blood loss and postpartum blood loss at 24 h in tamponade+hysterectomy group were the most (P < 0.01), followed by the tamponade + intervention group (P < 0.01), and the least in tamponade group (P < 0.01 and P < 0.05).The infusion of RBC suspension and plasma volume in tamponade+hysterectomy group were higher than those in tamponade + intervention group and tamponade group (P < 0.01), and there was no statistical significance of which between tamponade + intervention group and tamponade group (P>0.05).The results of postoperative conditions showed that the postoperative fever time in gauze group was higher than that in balloon group and interventional group (P < 0.05), but there was no statistical significance between balloon group and interventional group (P>0.05).The length of stay, postoperative fever days and duration of antibiotic use gradually increased according to the order of the tamponade group, tamponade + intervention group, tamponade + hysterectomy group (P < 0.05 to P < 0.01).A multi-factor analysis of 64 cases with successful hemostasis showed that the placental implantation and diffuse intravascular coagulation were the risk factors of hemostasis failure (P < 0.01).
ConclusionsThere is no significant difference in the hemostatic effect between intrauterine gauze packing and balloon compression, but the balloon compression hemostasis can reduce the incidence rate of puerperal infection.In combination with placenta implantation, abnormal coagulation function and poor hemostatic effect of tamponade and intervention, and the hysterectomy should be implemented as soon as possible.
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