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Surgery to Manage Postpartum Haemorrhage

If it is not possible to stop the bleeding by giving uterotonic drugs, stimulating contractions and pressing down on the uterus, other surgery may be necessary.

This page gives an overview of surgical techniques currently available, but some rely on specialist expertise or equipment which may not be available everywhere. If you want to look in more detail at the surgical techniques, it is recommended that you look in the medical textbooks referred to on the links page.

  1. Repair - where the bleeding is caused by a tear to the cervix, vagina or perineum, this should be repaired to stop the bleeding.

  2. Uterine tamponade - this requires developing pressure inside the uterus to stop the bleeding. It can be done in 2 ways:
    1. Uterine packing, using a gauze roll to press against the site of the bleeding.
    2. A balloon which is inserted into the uterus which is expanded using warm saline. When the uterus has been expanded sufficiently the bleeding should stop.

  3. Embolisation of uterine arteries - this is a technique done by radiologists whereby the uterine arteries are deliberately blocked by the introduction of, for example, gelatine particles. This is reported to be very successful and saves further surgical intervention. However it requires a team of interventional radiologists to be on hand for emergencies.

  4. The B-Lynch suture compression technique - this newly developed technique requires that an incision is made in the abdomen to expose the uterus and then 2 large stitches are put round the uterus to compress it and stop the bleeding.

  5. Internal iliac ligation - this involves the tying of various arteries within the pelvis to stop the bleeding. Because of the nature of the blood supply to the pelvis this can be done without causing future problems.

  6. Hysterectomy - This involves removing part or all of the uterus to stop the bleeding. This is usually done as a last resort or where the woman does not want to have children in the future. However some guidelines recommend that hysterectomy is performed sooner rather than later where surgeons are not experienced with the techniques described above. The incidence of hysterectomy following birth is thought to be in the region of 1 in 2000 births (Canada) to 1 in 2500 births (UK). [More information]