title: Uterine-sparing surgical management of postpartum hemorrhage: is it always effective?
abstract: OBJECTIVE
  To further study the efficacy of uterine-sparing procedures based on triple uterine artery ligation (TUAL) possibly complemented with hemostatic multiple square suturing (HMSS) for the management of post-partum hemorrhage (PPH).
  
  
  METHODS
  Cases of PPH occurring during cesarean section and treated, according to our institution guidelines, by TUAL possibly complemented with HMSS between 2000 and 2009 were retrospectively analyzed.
  
  
  RESULTS
  Fifty-six patients were included; 13 (23.2%) had TUAL only, while 43 (76.8%) had additional HMSS performed. Surgical conservative management of PPH was effective in 51 (91.1%) cases. PPH due to placenta accreta, either unanticipated or after failure of conservative management, showed an independent and significant impact on the risk of failure of the procedure (AOR 15.07, 95% CI 1.12-201.9, p = 0.041).
  
  
  CONCLUSIONS
  Obstetricians should be aware that a higher risk of failure of the procedure is to be expected in cases of PPH due to placenta accreta. In such situation, to avoid any useless delay in management, our findings suggest that peripartum hysterectomy should be immediately considered.
authors.affiliation: Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille (APHM), Hôpital Nord, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Blanc
authors.forename: Blandine
authors.initials: B
authors.lastname: Courbiere
authors.forename: Raoul
authors.initials: R
authors.lastname: Desbriere
authors.forename: Florence
authors.initials: F
authors.lastname: Bretelle
authors.forename: Léon
authors.initials: L
authors.lastname: Boubli
authors.forename: Claude
authors.initials: C
authors.lastname: D'Ercole
authors.forename: Xavier
authors.initials: X
authors.lastname: Carcopino
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D008026:Ligation; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques; D016896:Treatment Outcome; D055988:Uterine Artery / Q000601:surgery*; D014599:Uterus / Q000098:blood supply / Q000601:surgery*; D055815:Young Adult