Chandraharan Edwin, Arulkumaran Sabaratnam
St George's Hospital Medical School, London, UK.
Best Pract Res Clin Obstet Gynaecol. 2008 Dec;22(6):1089-102. doi: 10.1016/j.bpobgyn.2008.08.001. Epub 2008 Sep 14.
Postpartum haemorrhage (PPH) refers to excessive bleeding from the genital tract after birth. Failure of medical treatment to control bleeding would necessitate surgical measures to arrest haemorrhage, to save lives. Algorithms such as HAEMOSTASIS have been proposed as aids to the systematic and stepwise management of primary PPH. Clinicians need to be aware of various surgical techniques that could be employed to arrest haemorrhage, the appropriateness of a chosen surgical intervention to the specific clinical situation and the timing of instituting the intervention. Surgical measures to arrest PPH include repair of genital tract trauma, evacuation of retained products of conception, uterine balloon tamponade, exploratory laparotomy and uterine compression sutures, systematic pelvic devascularization, uterine artery embolization, subtotal and total abdominal hysterectomy. Consideration should also be given to the experience and the skill of the operator, as well as to the familiarity with the chosen surgical procedure.
产后出血（PPH）是指分娩后生殖道大量出血。若药物治疗无法控制出血，则需采取手术措施来止血以挽救生命。诸如HAEMOSTASIS等算法已被提出，作为原发性产后出血系统和逐步管理的辅助手段。临床医生需要了解可用于止血的各种手术技术、所选手术干预措施对特定临床情况的适用性以及实施干预的时机。止血的手术措施包括生殖道创伤修复、清除残留妊娠产物、子宫球囊压迫、剖腹探查和子宫压迫缝合、系统性盆腔去血管化、子宫动脉栓塞、次全子宫切除术和全子宫切除术。还应考虑手术者的经验和技能，以及对所选手术程序的熟悉程度。
