Lower uterine segment compression for management of early postpartum hemorrhage after vaginal delivery at Charoenkrung Pracharak Hospital

Abstract

Objective: 1. To evaluate the efficacy of lower uterine compression method in treatment of postpartum hemorrhage (PPH). 2. To compare the amount of blood loss in PPH between the lower uterine compression method and the conventional treatment. Study design: Randomized control trial. Material and Method: This Randomized control trial was done at the Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok, between January and August 2008. During the study period, 66 cases of PPH were identified. Two patients were excluded from the present study due to cervical tear and extensive birth canal tear. Sixty-four patients met all inclusion criteria and were included in the present study. Thirty-two patients were randomly assigned to the conventional protocol and the other 32 were managed by the conventional protocol with the addition of lower uterine compression. The lower uterine compression treatment was started promptly together with other modalities of PPH treatment. This technique can be performed by using one hand to compress tightly at the lower segment of uterus for 10 minutes. Main outcome measurement: The amount of blood loss in both control and experiment groups were collected after treatment of PPH for 2 hours postpartum. Results: In all 64 cases, the blood loss after treatment in the conventional group is statistically significantly higher than the blood loss in the group that received lower uterine compression (225 ± 401 ml vs. 120 ± 211 ml; p = 0.026). The addition of lower uterine compression resulted in 105 ml or 47% reduction of blood loss. Conclusion: The lower uterine compression method is a very effective procedure for treating PPH. It is simple to use, safe and no cost. This technique is an innovative scheme in the obstetrics field. The more efficient treatment of PPH would have a positive impact on the outcome of many patients who have postpartum hemorrhage, leading to the reduction in morbidity or even save the lives of patients.