Postpartum hemorrhage outcome in lower uterine segment compression maneuver: A 20-year experience in Charoenkrung Pracharak hospital

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Objective: Primary objectives were: 1) To compare the incidence of postpartum hemorrhage [PPH] between the patients who received lower uterine segment compression [LUSC] in conjunction to their standard delivery care and those who received only standard delivery care and 2) to compare the incidence of PPH after the labor room staff were trained to perform LUSC in addition to standard delivery care. Secondary objective was to compare blood loss, disseminated intravascular coagulopathy [DIC], and hysterectomy between patient in LUSC and non-LUSC groups. Materials and Methods: The retrospective study was conducted in Charoenkrung Pracharak Hospital. The data had been collected between 1994 and 2013 where normal labors from any gestational ages were considered eligible for the study. The study consisted of two phases; from 1994 to 2003, and 2004 to 2013. Data collected consisted of the incidences of PPH, the volume of blood loss, and complications arisen from PPH such as DIC and the need to perform hysterectomy. The subjects were divided into two groups: one receiving only standard delivery procedure, and another receiving LUSC. Results: During 20 years of the study, there were 77,081 cases of normal labor, 2,740 of which had PPH. The study was divided into two phases. Phase 1 (1994 to 2003), the incidence of PPH in patients who received LUSC was significantly lower than the patients who delivered with only standard delivery care (2.03±0.72 versus 4.46±0.66, p<0.001). Phase 2 (2004 to 2013), the labor room staff were trained to perform LUSC. The incidence of PPH in the first 10 years (1994 to 2003) when nurses performed standard delivery procedure was significantly higher than 10 years later (2004 to 2013) when nurses had integrated LUSC into their delivery care (4.65±0.60 versus 2.16±0.74, p<0.001). No maternal death occurred throughout the study. There were 12 cases that needed hysterectomy as a complication from PPH, all of which were from non-LUSC group. Conclusion: From 20 years of experience using LUSC, it is observed that the incidence of PPH has both noticeably and statistically decreased as compared to patients who received only standard care. As such, the effectiveness and safety of LUSC was thoroughly demonstrated.