Division of Obstetrics and Gynaecology, Faculty of Medicine, University Hospital Aachen, Wendlingweg 2/MIT II, 52074, Aachen, Germany.
Arch Gynecol Obstet. 2012 Sep;286(3):549-61. doi: 10.1007/s00404-012-2329-z. Epub 2012 May 4.
Postpartum haemorrhage (PPH) remains to be the most common cause of maternal mortality and is responsible for 25 % of the maternal deaths worldwide. Although the absolute risk of maternal death is much lower, a recent increase of PPH and related maternal adverse outcomes has been noted in high-income countries as well. Generally, PPH requires early recognition of its cause, immediate control of the bleeding source by medical, mechanical, invasive-non-surgical and surgical procedures, rapid stabilization of the mother's condition, and a multidisciplinary approach. Second-line treatment of PPH remains challenging, since there is a lack of univocal recommendations from current guidelines and sufficient data from randomized controlled trials.
For this review, electronic searches were performed in PubMed, Embase, and the Cochrane Central Register of Controlled Trials using the keywords "postpartum haemorrhage" in combination with 'uterine tamponade' and, especially with 'arterial embolisation', 'uterine compression sutures', and 'post(peri)partum hysterectomy' (from January 2000 to November 2011). Reference lists of identified articles were searched and article references to the keywords selected.
Treatment options such as uterine compression sutures, embolisation, arterial ligation and hysterectomy were evaluated with regard to their prerequisites, benefits, drawbacks and respective success rate. In addition, a treatment algorithm for the second-line treatment of PPH is presented.
产后出血（PPH）仍然是产妇死亡的最常见原因，占全球产妇死亡的 25%。尽管产妇死亡的绝对风险较低，但最近在高收入国家也注意到 PPH 及其相关的产妇不良结局有所增加。一般来说，PPH 需要早期识别其病因，通过医疗、机械、侵入性非手术和手术程序立即控制出血源，迅速稳定母亲的状况，并采取多学科方法。PPH 的二线治疗仍然具有挑战性，因为目前的指南缺乏明确的建议，并且随机对照试验的数据也不足。
为了进行这项综述，我们在 PubMed、Embase 和 Cochrane 对照试验中心注册库中使用了关键词“产后出血”，并与“子宫填塞”，特别是“动脉栓塞”、“子宫压缩缝合”和“产后（围产期）子宫切除术”（从 2000 年 1 月到 2011 年 11 月）进行了电子搜索。还对已确定文章的参考文献列表进行了搜索，并对选择的关键字的文章参考文献进行了搜索。
评估了子宫压缩缝合、栓塞、动脉结扎和子宫切除术等治疗选择，重点关注其前提条件、益处、缺点和各自的成功率。此外，还提出了 PPH 二线治疗的治疗算法。
