Subsequent Pregnancy Outcomes After Conservative Treatment of Postpartum Hemorrhage Following Cesarean Delivery.

OBJECTIVE

This study aimed to investigate pregnancy outcomes after conservative treatment for severe postpartum hemorrhage (PPH) following cesarean delivery (CD).

METHODS

A total of 9,366 women who underwent CD for two consecutive pregnancies were included. Bakri balloon tamponade was employed in 87 women, and compression sutures were used in 87 women to control PPH during the first CD. The subsequent pregnancy outcomes and operative findings during the second CD were compared among the groups.

RESULTS

The preterm delivery rate was 3.2% in the control group, 12.6% in the Bakri group, and 11.5% in the compression suture group (P < 0.001). The rates of placenta accreta (1.4% vs. 1.3% vs. 5.3%, P = 0.017), PPH (0.9% vs. 3.9% vs. 8.0%, P < 0.001), and pelvic adhesions (5.2% vs. 6.5% vs. 13.3%, P = 0.004) were significantly greater in the compression suture group. After adjustment, conservative treatment increased the rate of preterm birth in subsequent pregnancies threefold. A compression suture increased the risk of placenta accreta by four fold and the incidence of pelvic adhesions by more than two fold in subsequent CD.

CONCLUSIONS

Conservative treatment for PPH following CD is associated with an increased risk of subsequent preterm birth. Women receiving compression sutures have an increased risk of placenta accreta and pelvic adhesions in subsequent pregnancies.