| Category | Intervention | Key Outcome(s) | Strength of Evidence Grade | Findings |
|---|---|---|---|---|
| Pharmacologic Interventions | Oxytocin and other uterotonics | Control of bleeding | Insufficient | Control of bleeding in 45/91 women (49%) receiving oxytocin and other uterotonics in a single short-term study with high study limitations. |
| Tranexamic acid vs. no tranexamic acid | Anemia, transfusion, blood loss, ICU stay | Insufficient | Less blood loss, need for transfusion, and progression to severe PPH in TXA group vs. control (p <.05) reported in a single small short-term cohort study with high study limitations. | |
| Misoprostol vs. methylergonovine maleate | Transfusion, uterine preservation | Insufficient for superiority of 1 agent over another in affecting any outcome | No group differences in need for transfusion or additional medical or surgical treatments in a single small short-term cohort study with high study limitations. | |
| Sulprostone | Success in controlling bleeding | Insufficient | In a single short-term study with high study limitations, bleeding was controlled in 83% of 1,370 women. | |
| Carboprost tromethamine | Success in controlling bleeding | Insufficient | In a single short-term study with high study limitations, bleeding was controlled by carboprost in 81% of 237 cases of PPH. | |
| Thrombomodulin vs. no thrombomodulin | Uterine preservation, bleeding, transfusion | Insufficient | Greater D-dimer decrease from baseline in intervention arm vs. control in a single small short-term cohort study with high study limitations. | |
| RFVIIa | Transfusion, anemia, uterine preservation, LOS | Insufficient | Need for transfusion was greater with rFVIIa in 1 small study with high study limitations and not different in another. Rates of hysterectomy, LOS were similar. | |
| Other Medical Interventions | Transfusion for supportive management of ongoing PPH | ICU admission, LOS | Insufficient | Inconsistency in direction of effect (greater LOS and ICU admission in transfusion or whole blood groups in 2 studies; no group differences in another study); high study limitations. |
| Procedures | Uterine tamponade | Success in controlling bleeding | Insufficient | Tamponade without further procedure or surgery controlled bleeding in 75-86% of women in 3 studies, and tamponade plus additional intervention controlled bleeding in 86-98% in another, but studies were small with high study limitations. |
| Embolization | Success in controlling bleeding | Low for positive effect in controlling bleeding | Median success rate of 89% as initial second-line intervention in 15 studies with high limitations; conservative management and severity of PPH varied across studies. A higher SOE is not possible due to the lack of comparisons in this literature and small sample sizes. | |
| Surgeries | Uterine compression sutures | Success in controlling bleeding | Insufficient | In 2 small studies with medium limitations, bleeding controlled by suture following conservative management in 60-70% of women. |
| Ligation | Success in controlling bleeding | Low for positive effect in controlling bleeding | 92% success rate for controlling bleeding without further procedure or surgeries in 3 small studies of ligation alone with medium study limitations. Ligation with or without suture controlled bleeding in 91% in 1 case series. | |
| Hysterectomy | LOS, ICU admission | Insufficient | Insufficient SOE due to few comparative studies, high limitations. | |
| Other Interventions | Combined interventions | LOS in women with primary and secondary PPH | Insufficient | Greater LOS in women with primary PPH undergoing procedures/surgeries vs. medical management in 1 small study with high limitations. No differences in LOS between surgical and medical management groups in 2 small studies with high limitations addressing secondary PPH. |
ICU = intensive care unit; KQ = Key Question; LOS = length of stay; PPH = postpartum hemorrhage; rFVIIa = recombinant activated factor VIIa; SOE = strength of evidence; TXA = tranexamic acid.
From: Executive Summary
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