SURGICAL INTERVENTION IN SEVERE POSTPARTUM HAEMORRHAGE

Abstract

Postpartum haemorrhage (PPH) is one of the major causes of maternal mortality and morbidity, defined as haemorrhage occurring within 24 h of childbirth. Postpartum haemorrhage can be categorized into primary, which takes place within the first one day after childbirth, and secondary, which happens anytime from 24 hours after birth up to six weeks after delivery. Among the cases of PPH, some are severe and fatal and hence need to be treated effectively and on time. Conservative methods are to some extent useful in controlling PPH but surgical management involves the use of special operations to address the problem. Objective: This proposed study aims to finally summarize the evidence about surgical interventions in the management of postpartum haemorrhage, including the effectiveness and side effect profile of various surgical techniques. Methods: This study type used a retrospective cohort design and the sample consisted of patients with severe PPH that needed surgical management. This paper used quantitative data and the data was gathered from the records of hospitals for five years. Some of the surgical management activities considered in the study were uterine artery ligation, B-Lynch suture, and hysterectomy. The variables measured were success rates, early clinical outcomes, late clinical recovery and early complications. Quantitative methods of data analysis used in this study include survival analysis tests and chi-square tests. Results: The study enrolled 150 patients with severe manifested PPH; 60% of the patients underwent uterine artery ligation; 25% of the patients required a B-Lynch suture performed; and 15% of the patients required a hysterectomy. Short-term effects revealed that both techniques provided effective control of bleeding, in 85% of cases did not require additional surgery in the form of a B-Lynch suture. It was also shown that 70% of the cases with uterine artery ligation were associated with long-term preservation of fertility. Hysterectomy had the highest complication rates; infection, organ damage, and higher maternal mortality of 5%. Conclusion: Uterine artery ligation as well as B-Lynch suture should be used in cases of severe PPH because during this procedure no tubal sterilization occurs and fertility can be preserved when selecting the right cases. Although hysterectomy remains the surgical option of choice, the procedure is fraught with some significant risks. The study confirms the necessity for early surgical management and the collaboration of multiple specialists to optimise maternal results in grave cases of PPH. More clinical research is required to optimize surgical approaches and to define the role of non-operative interventions to improve the patient’s prognosis.