Specific second‐line therapies for postpartum haemorrhage: a national cohort study

Please cite this paper as: Kayem G, Kurinczuk J, Alfirevic Z, Spark P, Brocklehurst P, Knight M. Specific second‐line therapies for postpartum haemorrhage: a national cohort study. BJOG 2011;118:856–864. Objective To describe the characteristics, management and outcomes of women undergoing specific second‐line therapies for postpartum haemorrhage (PPH). Design A population‐based descriptive study. Setting All 226 consultant‐led maternity units in the UK. Population All women delivering between September 2007 and March 2009. Methods Prospective identification of women with PPH managed with uterine compression sutures, pelvic vessel ligation, interventional radiological techniques and recombinant factor VIIa (rFVIIa) through the UK Obstetric Surveillance System (UKOSS). Women with a PPH successfully treated with an intrauterine balloon where none of the other techniques were used were not included in the study. Main outcome measures Usage and success rates with 95% confidence intervals. Results A specific second‐line treatment was used in 272 women representing an estimated rate of use of 2.2 cases per 10 000 women delivering (95% CI 1.9–2.5/10 000). Sixty‐seven women (25%) were managed with intrauterine tamponade to treat PPH prior to the use of one of the specific second‐line therapies. As the first second‐line therapy, uterine compression sutures were successful in 120 women (75%; 95% CI 67–81%), pelvic vessel ligation was successful in five women (36%; 95% CI 13–65%) interventional radiology was successful in 12 women (86%; 95% CI 57–98%) and rFVIIa was successful in five women (31%; 95% CI 11–59%). Rates of success were not significantly different in cases managed first with intrauterine tamponade. Overall, 71 (26%) women had a hysterectomy. Conclusions Overall, a quarter of women treated had a hysterectomy as a rescue therapy. Uterine compression sutures and interventional radiological techniques have higher success rates than rFVIIa and pelvic vessel ligation. However, cases managed with rFVIIa and ligation tend to be more clinically complex.