Post-partum hemorrhage: Can it be prevented by assisting the natural physiological process?

Abstract

Background. Anteversion of the uterus is essential for the abdominal pregnant uterus growth and for the uterine contraction during labor and post-partum period. The role of the round ligaments is not yet completely understood, but certainly do have a coherent synergistic role with that of the neo-myometrium. The uterine contraction depends not only by the uterine muscle fibers, but also by the integrated pelvic myofascial system, connecting the uterine body to the round ligaments, to the ileo-psoas muscles and to the abdominal wall. In view of these functional anatomy reflections, it is possible to understand the procedures used in our management of postpartum hemorrhage and in our study. Materials and methods. We have a retrospective observational study of a population of 5927 women who delivered by Cesarean Section or vaginal labor between 2014 and 2018, after the 34th gestational week. Of these, 173 women with risk factors for postpartum hemorrhage (PPH) or with mild PPH were treated with a non-invasive method consisting of an abdominal band for uterine compression/anteversion, in combination with standard drug or surgical therapy. Results. We had only one peripartum hysterectomy on 5927 birth 0.016/1000 (Italy-ItOSS 1.08/1000, Regno Unit UKOSSNethOSS- Nord Europa NOSS 0.3-0.4/1000). Five women received 4 or more blood transfusions on 5927 delivers (0.85/1000). Conclusions. The non-invasive uterine compression technique reduced the incidence of PPH in high-risk women and prevented maternal morbidity and mortality.