alexa Outcome of the management of massive postpartum hemorrhage using the algorithm "HEMOSTASIS".
Reproductive Medicine

Reproductive Medicine

Gynecology & Obstetrics

Author(s): Varatharajan L, Chandraharan E, Sutton J, Lowe V, Arulkumaran S

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Abstract OBJECTIVE: To evaluate whether the algorithm "HEMOSTASIS" (help; establish etiology; massage the uterus; oxytocin infusion and prostaglandins; shift to operating theater; tamponade test; apply compression sutures; systematic pelvic devascularization; interventional radiology; subtotal/total abdominal hysterectomy) was of value in the systematic management of postpartum hemorrhage (PPH). METHODS: A retrospective analysis was performed of all women who experienced massive primary PPH (blood loss >1500mL) in 2008 at St George's Hospital, London, UK. The success of the HEMOSTASIS mnemonic in PPH management was determined by assessing clinical outcome following adherence to the protocol. RESULTS: Patient notes were available for 95 (83.3\%) of the 114 cases of primary PPH. Hemostasis was achieved in 63 (66.3\%) women via use of additional oxytocics ("O"); 19 (20.0\%) via suture of tears and 10 (10.5\%) via tamponade ("T"); 1 (1.1\%) via application of compression suture ("A"); 1 (1.1\%) via systematic devascularization ("S"); and 1 (1.1\%) via subtotal/total hysterectomy ("S"). There were no maternal deaths. CONCLUSION: The decremental pattern of more complex interventions used demonstrates that the algorithm can provide a logical management pathway to reduce blood transfusions, hysterectomies, admissions to intensive care units, and maternal deaths. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved. This article was published in Int J Gynaecol Obstet and referenced in Gynecology & Obstetrics

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