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CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(10): 679-686
DOI: 10.1055/s-0040-1719159
Febrasgo Position Statement

Surgical management of postpartum hemorrhage

Number 4 - October 2020
Álvaro Luiz Lage Alves 
1   Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
,
Gilberto Nagahama 
2   Maternidade Escola Vila Nova Cachoeirinha, São Paulo, SP, Brazil
,
Alexandre Massao Nozaki 
3   Hospital Maternidade Interlagos, São Paulo, SP, Brazil
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Key-points

  • Postpartum hemorrhage is the world’s leading cause of peripartum hysterectomy, even among women with a desire for future fertility.

  • Vascular ligation and uterine compression sutures must precede hysterectomy in the surgical treatment of postpartum hemorrhage.

  • The main technique of vascular ligation is bilateral uterine artery occlusion, although progressive devascularization techniques may optimize the surgical control of postpartum hemorrhage.

  • Uterine compression sutures are heterogeneous and the choice of technique to be applied must correlate with the hemorrhage etiology and the topography of the hemorrhagic focus.

  • The combination of uterine compression suture and vascular ligation increases the effectiveness of surgical treatment of postpartum hemorrhage.

  • Surgical techniques for controlling postpartum hemorrhage should be used immediately after failure of drug therapy, preferably within the “golden hour”.

  • All pregnant women with placenta previa and previous cesarean section must have assisted birth in a tertiary service.

  • Damage control surgery is indicated when the patient with postpartum hemorrhage is already in the lethal triad and definitive interruption of bleeding was not possible or requires excessive time.

The National Specialty Commission for Obstetric Emergencies of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) endorses to this document. The content production is based on scientific studies on a thematic proposal and the findings presented contribute to clinical practice.




Publication History

Article published online:
31 October 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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