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The surgical approach to postpartum haemorrhage

^1. Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
^2. Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK Email: p.steer{at}imperial.ac.uk (corresponding author)

Key content:

• Pharmaceutical treatment of postpartum haemorrhage is well defined.
  
• Physical methods for controlling postpartum haemorrhage that conserve the uterus include intrauterine balloons if the abdomen is closed or, at laparotomy, uterine compression sutures, uterine artery ligation, internal iliac artery ligation and aortic compression.
  
• If the above measures fail, hysterectomy should be undertaken sooner rather than later.
  
• In cases of uterine inversion, the ventouse can be used either vaginally or abdominally to help reduce the inversion.
  
• Surgery for placenta praevia/accreta should be planned carefully in advance.
  

Learning objectives:

• To understand the range of physical techniques available for controlling postpartum haemorrhage.
  
• To learn about a variety of ways to correct uterine inversion.
  
• To understand how to prepare for and conduct surgery for placenta praevia/accreta.
  

Ethical issues:

• Prior informed consent for hysterectomy can be problematic in an emergency situation.
  
• Operations for placenta praevia/accreta need to be especially carefully planned if a woman declines the use of blood transfusion.
  
• There is little authoritative information to give women about the benefits and disadvantages of the various surgical techniques.
  

Please cite this article as: Steer PJ. The surgical approach to postpartum haemorrhage. The Obstetrician & Gynaecologist 2009;11:231–238.

Keywords hysterectomy / intrauterine tamponade balloon / placenta accreta / placenta praevia / postpartum haemorrhage / uterine artery ligation / uterine compression suture