title: Appropriate second-line therapies for management of severe postpartum hemorrhage.
abstract: OBJECTIVE
  To explore appropriate second-line therapies for management of severe postpartum hemorrhage at cesarean delivery.
  
  
  METHODS
  A retrospective study was done of 87 women who underwent cesarean delivery and received uterotonics after placental separation at the Beijing Haidian Maternal and Child Health Hospital, China, between 2009 and 2013. Group 1 (n=52) included patients with 500-700 mL of blood loss before application of intrauterine gauze tamponade or B-Lynch suture as second-line therapy, while group 2 (n=35) included patients with blood loss of more than 700 mL before application of either gauze tamponade or B-Lynch suture.
  
  
  RESULTS
  Management was successful in all patients in group 1. In group 2, additional management was needed in three of four patients who underwent a B-lynch suture. Factors significantly associated with total blood loss were blood loss before application of second-line therapy (P<0.001), fibrinogen levels (P<0.001), and time from placental separation to second-line therapy (P=0.015).
  
  
  CONCLUSIONS
  When blood loss is 500-700 mL, compression sutures or intrauterine gauze tamponade can be used as second-line treatment of postpartum hemorrhage. When blood loss is more than 700 mL, intrauterine gauze tamponade should be used.
authors.affiliation: Department of Obstetrics, Beijing Haidian Maternal and Child Health Hospital, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Obstetrics, Beijing Haidian Maternal and Child Health Hospital, Beijing, China. Electronic address: zhangyp7090@yahoo.cn.
authors.forename: Yunping
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, Dalian Central Hospital, Dalian Medical University, Dalian, China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Li
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003131:Combined Modality Therapy; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D007744:Obstetric Labor Complications; D010120:Oxytocics / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D013536:Suture Techniques; D058738:Uterine Balloon Tamponade
chemical_list: D010120:Oxytocics
keywords: B-Lynch suture; Cesarean delivery; Intrauterine gauze tamponade; Management; Postpartum hemorrhage; Second-line therapy