School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
Department of Obstetrics, Royal Hospital for Women, Sydney, NSW, Australia.
BMC Pregnancy Childbirth. 2020 Apr 25;20(1):245. doi: 10.1186/s12884-020-02916-w.
Bimanual clot evacuation (BCE) is a simple clinical manoeuvre that may reduce need for surgical intervention in the management of severe postpartum haemorrhage (PPH). We sought to determine whether performing BCE in cases of severe PPH after vaginal birth reduces the need for surgical intervention.
A retrospective chart review of women who delivered vaginally with a severe PPH between January 1, 2011 and December 31, 2014 in a single tertiary women's hospital in Sydney, Australia was conducted. Severe PPH was classified as a blood loss ≥1000mls. The need for surgical management (including operating theatre uterine exploration or evacuation, intrauterine balloon tamponade, repair of significant trauma, uterine or internal iliac artery ligation, B-Lynch suture insertion or hysterectomy) was the primary outcome measure, as expressed by need for operating theatre utilisation.
From a cohort of 438, 149 women (34.0%) had BCE, of whom 29 (19.5%) required surgical management compared to 103 of 289 women with no BCE (35.6%); an odds ratio (OR) of 0.38 for BCE (confidence interval 0.20-0.72; p = 0.003). Early BCE (< 1 h of delivery) was associated with a further reduction in surgery (OR 0.24; confidence interval 0.08-0.70; p = 0.009) compared to late BCE (> 1 h of delivery). There was no reduction in estimated blood loss (p = 0.86) or blood transfusion (p = 0.71) with BCE.
Our study suggests BCE reduces theatre utilisation in the context of severe PPH following vaginal delivery. Prospective trials are needed to determine whether BCE should be endorsed as a treatment modality for PPH post-vaginal delivery.
双手压迫子宫排出（BCE）是一种简单的临床操作，可能会减少阴道分娩后严重产后出血（PPH）管理中手术干预的需求。我们旨在确定阴道分娩后发生严重 PPH 时行 BCE 是否会减少手术干预的需求。
对 2011 年 1 月 1 日至 2014 年 12 月 31 日期间在澳大利亚悉尼的一家单一三级妇女医院阴道分娩且发生严重 PPH 的女性进行了回顾性图表审查。严重 PPH 定义为出血量≥1000ml。手术管理的需求（包括手术室子宫探查或排空、宫内球囊填塞、严重创伤修复、子宫或内髂动脉结扎、B-Lynch 缝合插入或子宫切除术）是主要的观察结局，通过手术室利用情况来表示。
在 438149 名女性（34.0%）中进行了 BCE，其中 29 名（19.5%）需要手术管理，而 289 名未行 BCE 的女性中有 103 名（35.6%）需要手术管理；BCE 的比值比（OR）为 0.38（置信区间 0.20-0.72；p=0.003）。早期 BCE（分娩后<1 小时）与手术进一步减少相关（OR 0.24；置信区间 0.08-0.70；p=0.009），而晚期 BCE（分娩后>1 小时）则不然。BCE 并没有减少估计出血量（p=0.86）或输血（p=0.71）。
我们的研究表明，BCE 可降低阴道分娩后严重 PPH 情况下的手术室利用。需要前瞻性试验来确定 BCE 是否应被认可为阴道分娩后 PPH 的治疗方法。
