Management of immediate postcesarean section hemorrhage

From Jan 1, 1982, to Dec 31, 1985, 33 (1.3%) of 2,545 women undergoing cesarean section experienced an immediate estimated blood loss > 1,000 mL. In all cases, the etiology was uterine atony. Medical management was unsuccessful in 20 (60.6%) cases, and hysterectomy was necessary in ten. Conservative surgical management (hypogastric or uterine artery ligation or both) was used in 18 cases and was successful in ten (55.6%). Patients who responded to medical management had a mean estimated blood loss of 1,469 mL, compared to a loss of 2,120 mL, for those responding to ligation and a loss of 3,240 mL for those requiring hysterectomy (P < 0.001). Hysterectomy is the definitive procedure for the hemodynamically unstable patient with intractable obstetric hemorrhage if rapid bilateral uterine artery ligation fails. Hypogastric or uterine artery ligation is recommended for the hemodynamically stable patient who is desirous of future childbearing.