The efficacy of lower uterine segment compression for prevention of early postpartum hemorrhage after vaginal delivery.

OBJECTIVE

To determine the efficacy and amount of blood loss of the maneuver utilizing lower uterine segment compression (LUSC) for the prevention of early postpartum hemorrhage.

MATERIAL AND METHOD

The present study enrolled 686 mothers with singleton pregnancy, gestational ages between 28 and 42 weeks, at the Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok between July 2009 and March 2010. All subjects had no past medical history and delivered by vaginal route. They were divided into two groups, the experimental group and the control group. Mothers in both experimental and control groups were treated with the same methods, oxytocin administration before and after delivery, clamping and cutting umbilical cords within three minutes after birth of the newborns, and placental delivery done by controlled cord traction together with uterine massage at the fundus through the abdominal wall immediately. In addition, in the experimental group, the subjects were assisted by LUSC for 10 minutes. The amount of blood loss was measured and recorded two hours after delivery of the placentas in both experimental and control groups.

RESULTS

Among 686 cases, nine cases were excluded from the present study. They were composed of five cases in the control group, with retained placenta, and four cases in the experimental group because of retained placenta, retained placental fragments, severe perineum tear, and vaginal hematoma. Subjects in the experimental group who were additionally assisted by LUSC were found to have lesser incidence of PPH with statistical significance in comparison to those in the control group (2.9% vs. 6.8%; relative risk 0.43, 95% confidence interval 0.21-0.90, p = 0.02). The amount of blood loss reduced by 29.26 ml (289.70 +/- 179.53 mlvs. 260.44 +/- 116.30 ml), p = 0.012).

CONCLUSION

Lower uterine segment compression (LUSC) significantly reduced the rate of PPH and amount of blood loss after vaginal delivery The efficacy of this technique was over the conventional method in labor room care. Besides, LUSC was easy and safe. Neither anesthesia nor extra-expense was needed. LUSC was considered the innovation for management of postpartum hemorrhage. The maneuver was able to reduce the risk of maternal morbidity and mortality after the delivery of newborns.