title: Novel combined strategy of obstetric haemorrhage management during caesarean section using intrauterine balloon tamponade.
abstract: OBJECTIVE
  The aim of this trial was to evaluate the performance of a combined strategy of postpartum haemorrhage management, based upon thromboelastographic (TEG) assessment of coagulation, early surgical haemostasis and mechanical compression of the uterine wall combined with uterine cavity draining, via intrauterine balloon tamponade (BT).
  
  
  METHODS
  We carried out an open controlled trial, which included 119 women with obstetric haemorrhage (main group - combined strategy: n = 90, control group - conventional strategy: n = 29). The combined strategy included three essential components: (1) early surgical haemostasis, (2) mechanical pressure upon the uterine wall and draining of the uterine cavity via BT and (3) treatment of blood coagulation disorders identified via TEG.
  
  
  RESULTS
  The combined haemorrhage management strategy resulted in significantly lower number of peripartum hysterectomies compared with standard management (4.44% versus 31.03%, respectively, p = 0.02). Blood loss of >2000 ml occurred significantly less common in the main group compared with the control group (16.2% versus 27.6%, respectively, p = 0.03). Mean total blood loss after combined management was significantly lower than after the standard approach (2502 ± 203 ml versus 1836 ± 108 ml, p = 0.04).
  
  
  CONCLUSIONS
  The proposed combined strategy of obstetric haemorrhage management represents a powerful tool for fertility-sparing treatment of this life-threatening condition.
authors.affiliation: a Omsk State Medical Academy , Omsk , Russian Federation and.
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Barinov
authors.affiliation: b JSC Gynamed , Moscow , Russian Federation.
authors.forename: Yakov G
authors.initials: YG
authors.lastname: Zhukovsky
authors.affiliation: a Omsk State Medical Academy , Omsk , Russian Federation and.
authors.forename: Vladimir T
authors.initials: VT
authors.lastname: Dolgikh
authors.affiliation: a Omsk State Medical Academy , Omsk , Russian Federation and.
authors.forename: Irina V
authors.initials: IV
authors.lastname: Medyannikova
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002585:Cesarean Section; D003131:Combined Modality Therapy; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D013916:Thrombelastography; D016896:Treatment Outcome; D058738:Uterine Balloon Tamponade
keywords: Haemostatic external uterine supraplacental assembly suture; intrauterine balloon tamponade; obstetric haemorrhage; thromboelastography; uterine vessel ligation