title: Procedures and Uterine-Sparing Surgeries for Managing Postpartum Hemorrhage: A Systematic Review.
abstract: OBJECTIVE
  Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide.
  
  
  OBJECTIVE
  The aim of this study was to systematically review literature on procedures (eg, uterine artery embolization) and uterine-sparing surgeries for PPH.
  
  
  METHODS
  We searched MEDLINE and other databases from 1990 to November 2014. Two reviewers independently evaluated studies against predetermined criteria, extracted data, and assessed study quality and strength of the evidence (confidence in the effect).
  
  
  RESULTS
  Twenty-eight small studies addressed 1 or more procedures (19 studies of embolization, 5 of uterine tamponade) or surgeries (5 studies of arterial ligation, 5 of uterine compression sutures). Studies primarily evaluated bleeding control and adverse effects. Rates of hemostasis were typically greater than 60% in studies reporting such data after failure of conservative management. Postprocedure infertility occurred in 0% to 43% of women in a small number of studies that reported these data. Uterine tamponade successfully controlled bleeding in more than 50% of women, with few harms reported. Success rates for ligation and sutures ranged from 36% to 96%; harms included surgical injury, infection, and fertility-associated effects.
  
  
  CONCLUSIONS
  A limited body of evidence addresses these interventions for PPH. Median rates of hemostasis ranged from 36% to 98%; however, these data come from few studies with less than 2100 total participants. Harms were not well characterized. Some studies with longer-term follow-up reported infertility in women undergoing embolization. Few adverse events with tamponade, ligation, or sutures were reported. Given the insufficient evidence, clinicians must continue to make individual care decisions based on each woman's clinical situation and available management options.
authors.affiliation: Assistant Director, Vanderbilt Evidence-Based Practice Center; Assistant in Health Policy, Department of Health Policy, Vanderbilt University Medical Center.
authors.forename: Nila A
authors.initials: NA
authors.lastname: Sathe
authors.affiliation: Adjunct Assistant Professor, Vanderbilt University School of Nursing.
authors.forename: Frances E
authors.initials: FE
authors.lastname: Likis
authors.affiliation: Assistant Professor, Department of Obstetrics and Gynecology.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Young
authors.affiliation: Assistant Professor of Medicine, Division of Hematology/Oncology.
authors.forename: Alicia
authors.initials: A
authors.lastname: Morgans
authors.affiliation: Research Assistant Professor, Department of Health Policy, Vanderbilt University Medical Center.
authors.forename: Daphne
authors.initials: D
authors.lastname: Carlson-Bremer
authors.affiliation: Senior Scientist, Vanderbilt Evidence-Based Practice Center, Nashville, TN.
authors.forename: Jeff
authors.initials: J
authors.lastname: Andrews
mesh_terms: D021721:Balloon Occlusion / Q000009:adverse effects; D005260:Female; D006801:Humans; D059351:Organ Sparing Treatments; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D055357:Uterine Artery Embolization / Q000009:adverse effects / Q000379:methods; D014599:Uterus / Q000503:physiopathology