Outcome of the management of massive postpartum hemorrhage using the algorithm “HEMOSTASIS”

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.