Experience managing postpartum hemorrhage at Minia University Maternity Hospital, Egypt: No mortality using external aortic compression

AIM: To compare maternal mortality and morbidity due to postpartum hemorrhage (PPH) at Minia University Maternity Hospital, El-Minia, Egypt, before and while external aortic compression was applied as an adjunct intervention, and to identify the effect of aortic compression. METHODS: The obstetric data and outcomes of women with PPH were compared for the period 1999 through 2007, when only a regular PPH management protocol was followed, and for 2008 through 2009, when external aortic compression was applied before initiating the protocol. The El-Minia aortic compression device (EACD) was used in 2008 and the manual aortic compression maneuver (MACM) in 2009. Outcomes and treatment measures were analyzed by the ×2 test and multivariate regression. RESULTS: During the first period, PPH annually caused 1-6 deaths and 22-31 severe conditions, such as acute renal failure, loss of consciousness, anemia persisting after treatment, postpartum infection, or the need for a hysterectomy. The incidence of PPH declined from 4.6% in 1999 to 0.9% at the end of the study. In 2008 and 2009, there were no deaths due to PPH and only four complications were recorded in each of these two years. Regression analysis identified aortic compression as the second most effective measure preventing severe shock and death, with blood transfusions being the first. The almost similar results reached with the EACD and MACM allow a choice, but fewer units of blood were needed following application of the device. CONCLUSIONS: Including the EACD and MACM in the regular management protocol may improve the outcome of severe PPH.