Postpartum Hemorrhage Outcome in Lower Uterine
Segment Compression Maneuver: A 20-Year Experience
in Charoenkrung Pracharak Hospital
Wanchai Chantrapitak MD1, Wisude Anansakalwat MD1, Sawittri Suwikrom MD1, Renu Wattanaluangarun MSc1,
Supalarp Puangsa-art MSc2
Affiliation :
1 Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
2 Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Objective : Primary objectives were: 1) To compare the incidence of postpartum hemorrhage [PPH] between the patients who
received lower uterine segment compression [LUSC] in conjunction to their standard delivery care and those who received only
standard delivery care and 2) to compare the incidence of PPH after the labor room staff were trained to perform LUSC in addition
to standard delivery care. Secondary objective was to compare blood loss, disseminated intravascular coagulopathy [DIC], and
hysterectomy between patient in LUSC and non-LUSC groups.
Materials and Methods : The retrospective study was conducted in Charoenkrung Pracharak Hospital. The data had been collected
between 1994 and 2013 where normal labors from any gestational ages were considered eligible for the study. The study consisted
of two phases; from 1994 to 2003, and 2004 to 2013. Data collected consisted of the incidences of PPH, the volume of blood loss,
and complications arisen from PPH such as DIC and the need to perform hysterectomy. The subjects were divided into two groups:
one receiving only standard delivery procedure, and another receiving LUSC.
Results : During 20 years of the study, there were 77,081 cases of normal labor, 2,740 of which had PPH. The study was divided into
two phases. Phase 1 (1994 to 2003), the incidence of PPH in patients who received LUSC was signi(cid:976)icantly lower than the patients
who delivered with only standard delivery care (2.03±0.72 versus 4.46±0.66, p<0.001). Phase 2 (2004 to 2013), the labor room
staff were trained to perform LUSC. The incidence of PPH in the (cid:976)irst 10 years (1994 to 2003) when nurses performed standard
delivery procedure was signi(cid:976)icantly higher than 10 years later (2004 to 2013) when nurses had integrated LUSC into their delivery
care (4.65±0.60 versus 2.16±0.74, p<0.001). No maternal death occurred throughout the study. There were 12 cases that needed
hysterectomy as a complication from PPH, all of which were from non-LUSC group.
Conclusion : From 20 years of experience using LUSC, it is observed that the incidence of PPH has both noticeably and statistically
decreased as compared to patients who received only standard care. As such, the effectiveness and safety of LUSC was thoroughly
demonstrated.
Keywords : Lower uterine segment compression, Postpartum hemorrhage, Active management of third stage of labor
All Articles
Download