title: Maternal and perinatal outcome of massive postpartum hemorrhage: a review of 33 cases.
abstract: BACKGROUND
  Postpartum hemorrhage is a significant contributor to maternal morbidity and mortality.
  
  
  METHODS
  We evaluated maternal and perinatal outcome of primary massive postpartum hemorrhage. In a restrospective case analysis of 33 women with intractable postpartum hemorrhage initially managed either by hysterectomy or a conservative approach in a tertiary referral center between January 1, 1991 to December 30, 1998, we reviewed the procedures used as a primary or secondary attempt to arrest the hemorrhage.
  
  
  RESULTS
  Medical and surgical measures were successful in controlling hemorrhage in 21 (63.6%) of the 33 women. Hemorrhage was successfully arrested by conservative surgery in 13 cases, and by medical management in 8 cases. Emergency hysterectomy was performed in 12 cases (0.7 per 1000 deliveries) No maternal deaths occurred, but there were 2 early neonatal deaths (6.1 %). Atony of the uterus was the main cause of hemorrhage (n=15). Genital tract laceration was associated with a worse prognosis, but the time lapse between delivery and surgery appears to be the main prognostic factor.
  
  
  CONCLUSIONS
  Uterine atony and morbid adherent placenta are major causes of massive obstetric hemorrhage. In our series, morbidity was high, but there was no mortality. Obstetricians should identify women at risk which is especially associated with a prior cesarean delivery, a current placenta previa and high parity. Early intervention and proper procedure could minimize the complications.
authors.affiliation: Department of Obstretrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
authors.forename: Tarik Y
authors.initials: TY
authors.lastname: Zamzami