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KMID : 0948320060060010025
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Konyang Medical Journal
2006 Volume.6 No. 1 p.25 ~ p.35
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Clinical Analysis and Current Management of Postpartum Hemorrhage at One University Hospital in Daejeon ; 2000~2005
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Nam An-Na
Hur Sung-Eun
Lee Sung-Ki
Lee Ji-Young
Kim Gyung-Jin
Jang Byoung-Woo
Ann Mi-Jin
Kil Ki-Hyun
Han Hye-Jeong
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Abstract
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Objectives: Postpartum hemorrhage(PPH) has great significance as one of the leading causes of maternal mortality. This study was performed in order to find out clinical characteristics and the effect of treatment for postpartum hemorrhage and contribute to prevention and reduction in maternal mortality.
Methods: This study was performed retrospectively on the clinical records of 90 patients who experienced PPH at the department of Obstetrics and Gynecology of Konyang University Hospital from February 1, 2000 to September 30, 2005.
Results: The following is the result;
1. Overall incidence of postpartum hemorrhage was 1.44%. The incidence of immediate PPH was 1.28% and that of delayed PPH was 0.16%.
2. The main causes of immediate PPH were uterine atony (52.8%), abnormal placentation (22.2%) and laceration of genital tract (9.7%) in order of incidence. The main causes of delayed PPH were retained placenta (61.6%), subinvolution of uterus (27.8%) and bleeding of episiotomy site (11.1%).
3. The predisposing factors of immediate PPH such as placenta previa, pregnancy induced hypertension, induced labor and large uterus were found.
4. Immediate PPH occurred within 1 hour in 87.5% of the cases and delayed PPH occurred at the same distribution between after 2nd day and 6 weeks.
5. The final treatments of PPH were medical or balloon tamponade (72.2%), embolization or ligation (17.8%), and hysterectomy (10.0%).
6. Just one hysterectomy has been since 2004 years, when there was the active application of ballooning treatment of PPH.
7. The complication of PPH was found in 80.0% of the case: which were postpartum anemia 76.4% and fever 47.2%. The maternal mortality hadn’t occurred.
Conclusions: Postpartum hemorrhage should be managed by multidisciplinary approaches to prompt diagnosis with
appropriated replacement of blood loss. At the first, uterotonic drugs should be administrated before postpartum hemorrhage,
and then, if possible, followed by conservative treatment (balloon tamponade, embolization and ligation).
Hysterectomy should be considered as the last method.
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KEYWORD
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Postpartum Hemorrhage, Balloon tamponade, Embolization, Ligation, Hysterectomy
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