Outcomes and prognosis of postpartum hemorrhage according to management protocol: A 11-year retrospective study from two referral centers

Abstract Background No standard treatment guidelines have been established for postpartum hemorrhage (PPH). We aimed to assess the differences in outcomes between patients with PPH who underwent surgical and non-surgical treatments. Methods This retrospective study included 230 patients diagnosed with PPH at two referral hospitals between August 2013 and October 2023. The patients were divided into non-surgical intervention (group 1, n = 159), surgical intervention (group 2, n = 45), and surgical intervention after failure of non-surgical intervention (group 3, n = 26) groups. Results In each group, the initial heart rate and body temperature were significantly different (92.2 ± 20.7, 112.6 ± 30.4, and 102.1 ± 23.3 beats per minute, p < 0.001 and 37.3 ± 0.8°, 36.9 ± 0.9°, and 37.2 ± 0.9°, p = 0.016, in groups 1–3, respectively). Among the causes of PPH, uterine atony combined with other causes showed a significant difference among the three groups (32 cases (20.1%), 8 cases (17.8%), and 14 cases (53.8%), p = 0.003 in groups 1–3, respectively). Mean duration of hospitalization and intensive care unit admission rate were significantly different between the groups (4.1 ± 1.7, 8.7 ± 10.3, and 10.4 ± 13.6 days, p < 0.001 and 6 cases (3.8%), 17 cases (37.8%), and 12 cases (46.2%), p < 0.001 in groups 1–3, respectively). Hysterectomy and disseminated intravascular coagulopathy rates were significantly higher in group 3 than in group 2 [(19 cases (73.1%) and 23 cases (51.1%), x2 = 3.291, p = 0.047); 18 cases (69.2%) and 19 cases (42.2%), x2 = 4.817, p = 0.028), respectively]. Conclusions In patients with PPH and an initial increased heart rate or decreased body temperature and in those with causes combined with uterine atony, immediate surgical intervention improves the prognosis. Postoperative complications increased when surgery was performed after failure of non-surgical interventions.