How is trauma treated in postpartum hemorrhage (PPH)?

Updated: Jan 02, 2018
  • Author: Maame Yaa A B Yiadom, MD, MPH; Chief Editor: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE  more...
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Answer

Trauma

If lacerations or hematomas are found, direct pressure may help control bleeding. Actively bleeding perineal, vaginal, and cervical lacerations should be repaired. If brisk bleeding comes from the uterus, it may be urgently slowed by packing the uterine cavity. This may be accomplished by introducing a long vaginal pack into the cavity with dressing forceps. Alternatively (and usually more easily), a Bakri or Blakemore balloon may be introduced into the uterus and inflated. The balloon should be filled with as much saline as possible to produce adequate tamponade. It is important that the pack is placed into the uterus itself rather than into the vagina. If these devices are not available, a Foley catheter with a large balloon (30 mL or more) may be introduced into the lower uterine segment.

In a retrospective multicenter study, that evaluated maternal outcomes following uterine balloon tamponade in the management of primary postpartum hemorrhage after standard treatment had failed, Martin et al found an overall success rate of 65%. [22]  Of 17 failures, surgery was required in 16 cases, including hysterectomy in 11, and uterine artery embolization in one case. The investigators concluded that balloon tamponade is effective, safe, and accessible for treating primary postpartum hemorrhage, and it may reduce the need for invasive procedures. [22]

In a separate study that evaluated whether the timing of balloon tamponade and uterine artery embolization is associated with morbidity among women with postpartum hemorrhage, Howard and Grobman reported that earlier use of balloon tamponade among women experiencing postpartum hemorrhage is associated with decreased maternal morbidity. [23]

Hematomas should not be disrupted if they are unruptured. However, steady pressure may be applied to prevent expansion. If there is no other cause of blood loss, resuscitate the patient and admit her to the hospital with a plan to monitor the hematoma for expansion and follow her hemoglobin and hematocrit levels.


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