title: Surgical treatment of intractable postpartum hemorrhage and changing trends in modern obstetric perspective.
abstract: OBJECTIVE
  To update the prevalence and risk factors of intractable postpartum hemorrhage (IPH) and evaluate the effectiveness of surgical treatment modalities.
  
  
  METHODS
  Between January 2002 and January 2008, IPH diagnosis was made in 86 cases. They were evaluated retrospectively.
  
  
  RESULTS
  Placental implantation abnormalities were the leading cause, responsible for 45.6% of cases. Organ preserving surgery (OPS) methods were utilized in 47 cases, with a success rate of 76.6%. Among these cases, 11 were proceeded to hysterectomy. Hysterectomy was performed in 45 cases as definitive treatment.
  
  
  CONCLUSIONS
  Compression sutures were quite effective in controlling hemorrhage due to placenta accreta and previa. For women who are hemodynamically stable and desirous for future fertility, OPS modalities should be applied first. Shorter operating time, hospital stay and less blood transfusion were seen with subtotal type hysterectomy, so in case of nonbleeding lower uterine segment, subtotal type should be performed first.
authors.affiliation: Department of Obstetrics and Gynecology, Dr Zekai Tahir Burak Women Health, Education and Research Hospital, Saime Kadin Mahallesi, Calikavak Sokak, No 22/4 Abidinpasa-Mamak, Ankara, Turkey.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Gungor
authors.forename: Adnan
authors.initials: A
authors.lastname: Simsek
authors.forename: Alev Ozlem
authors.initials: AO
authors.lastname: Ozdemir
authors.forename: Mine
authors.initials: M
authors.lastname: Pektas
authors.forename: Nuri
authors.initials: N
authors.lastname: Danisman
authors.forename: Leyla
authors.initials: L
authors.lastname: Mollamahmutoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000639:trends*; D013513:Obstetric Surgical Procedures / Q000639:trends; D010921:Placenta Accreta / Q000601:surgery*; D010923:Placenta Previa / Q000601:surgery*; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000639:trends*; D014421:Turkey; D055815:Young Adult