Second-line treatment of postpartum haemorrhage (PPH)

Postpartum haemorrhage (PPH) remains to be the most common cause of maternal mortality and is responsible for 25 % of the maternal deaths worldwide. Although the absolute risk of maternal death is much lower, a recent increase of PPH and related maternal adverse outcomes has been noted in high-income countries as well. Generally, PPH requires early recognition of its cause, immediate control of the bleeding source by medical, mechanical, invasive-non-surgical and surgical procedures, rapid stabilization of the mother's condition, and a multidisciplinary approach. Second-line treatment of PPH remains challenging, since there is a lack of univocal recommendations from current guidelines and sufficient data from randomized controlled trials.For this review, electronic searches were performed in PubMed, Embase, and the Cochrane Central Register of Controlled Trials using the keywords "postpartum haemorrhage" in combination with 'uterine tamponade' and, especially with 'arterial embolisation', 'uterine compression sutures', and 'post(peri)partum hysterectomy' (from January 2000 to November 2011). Reference lists of identified articles were searched and article references to the keywords selected.Treatment options such as uterine compression sutures, embolisation, arterial ligation and hysterectomy were evaluated with regard to their prerequisites, benefits, drawbacks and respective success rate. In addition, a treatment algorithm for the second-line treatment of PPH is presented.