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Int J Gynaecol Obstet. 2011 May;113(2):152-4. doi: 10.1016/j.ijgo.2010.11.021. Epub 2011 Mar 10.

Outcome of the management of massive postpartum hemorrhage using the algorithm "HEMOSTASIS".

Author information

1
St George's University, London, UK. lavanya.varatharajan@gmail.com

Abstract

OBJECTIVE:

To evaluate whether the algorithm "HEMOSTASIS" (help; establish etiology; massage the uterus; oxytocin infusion and prostaglandins; shift to operating theater; tamponade test; apply compression sutures; systematic pelvic devascularization; interventional radiology; subtotal/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 >1500mL) 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.

PMID:
21396642
DOI:
10.1016/j.ijgo.2010.11.021
[Indexed for MEDLINE]

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