• Lai-Ling Chan, Tsz-Kin Lo, Wai-Lam Lau, Samuel Lau, Bassanio Law, Hin-Hung Tsang, and Wing-Cheong Leung.
• Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong Kong. cll442@ha.org.hk
• Int J Gynaecol Obstet. 2013 Sep 1;122(3):238-43.

ObjectiveTo determine rates of use and success of second-line therapies for massive primary postpartum hemorrhage (PPH).MethodsA retrospective cohort study was conducted among 91 women who gave birth at Kwong Wah Hospital, Hong Kong, between January 1, 2006, and December 31, 2011. Inclusion criteria were gestational age of at least 24 weeks and massive PPH (defined as blood loss ≥1500 mL within 24 hours after birth). Second-line therapies assessed were uterine compression sutures, uterine artery embolization, and balloon tamponade after failure of uterine massage and uterotonic agents to stop bleeding.ResultsThe rate of massive PPH was 2.65 per 1000 births. Second-line therapies were used among 42 women with PPH, equivalent to a rate of 1.23 per 1000 births. Only 21.4% of the women who received second-line therapies required rescue hysterectomy. A rising trend was observed for the use of second-line therapies, whereas the incidence of rescue hysterectomy and estimated blood loss were found to concomitantly decrease.ConclusionIncreasing use of second-line therapies among women with massive PPH was associated with a decreasing trend for rescue hysterectomy. Obstetricians should, therefore, consider all available interventions to stop PPH, including early use of second-line options.Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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