Original scientific paper

https://doi.org/10.20471/acc.2026.65.03.02

Treatment of Primary Postpartum Hemorrhage in a Tertiary Perinatal Center

Dubravko Habek ; University Department of Obstetrics and Gynecology, Clinical Hospital “Sveti Duh”, Zagreb, Croatia; University Department of Obstetrics and Gynecology, Clinical Hospital “Merkur”, Zagreb, Croatia; School of Medicine, Catholic University of Croatia, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia *
Mirjam Vitić ; School of Medicine, University of Zagreb, Zagreb, Croatia
Ana Marija Zdilar ; School of Medicine, University of Zagreb, Zagreb, Croatia
Vesna Elvedji Gašparović ; School of Medicine, University of Zagreb, Zagreb, Croatia; University Department of Obstetrics and Gynecology Clinical Hospital Centre Zagreb, Croatia
Dževada Kapić ; Department of Obstetrics and Gynecology, General Hospital Bihać, Bihać, Bosnia and Herzegovina

* Corresponding author.

Abstract

The aim of this study was to investigate the causes of primary postpartum hemorrhage
(PPPH) and the success of managing it in a tertiary perinatal center.
A clinical retrospective study was conducted at a tertiary perinatal center over
a ten-year period (2010–2019). Significant perinatal, maternal, and neonatal
data were investigated: maternal and neonatal data, possible causes of hemorrhage
and therapeutic approach.
Out of a total of 29 543 deliveries, PPPH was diagnosed in 215 (0.73%) parturients.
Uterine atony was diagnosed in 72.09%, uterine rupture in 1.39%, colpaporrhexis
in 0.47%, and cervicovaginal rupture in 20% of the parturients. A
retained placenta was recorded in 6.19% of the parturients, placenta accreta
spectrum disorders in 5.12%, disseminated intravascular coagulation in 3.26%,
and obstetric hemorrhagic shock developed in 3.72% parturients. Pharmacotherapy
was sufficient for PPPH management in 133 (61.86%) parturients. Abdominal
hemostatic procedures (B-Lynch, Cho, O’Leary) were performed in 32
cases (14.88%), and combined hemostatic and ligating methods in 10 (4.65%)
parturients. Transvaginal hemostatic procedures were performed in 18.10% of
the parturients: hemostatic sutures (Hebisch Huch, Habek, Losickaja) in 14.88%,
balloon/gauze tamponade in 1.86%, and combined hemostatic and tamponade
procedures in 1.39%. Peripartum hysterectomies were performed in 11 (5.12%)
parturients due to refractory bleeding and a morbidly adherent placenta. There
were no maternal deaths due to PPPH.
An adequately recognized etiology of PPPH with adherence to therapeutic
guidelines directly correlates with the perinatal outcome.

Keywords

Primary postpartum hemorrhage; Etiology; Management; Uterine sparing surgery; Peripartum hysterectomy

Hrčak ID:

351336

URI

https://hrcak.srce.hr/351336

Publication date:

28.9.2026.

Article data in other languages: croatian

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