Peripartum Haemorrhage, Diagnosis and Therapy. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry No. 015/063, March 2016)

. 2018 Apr 26;78(4):382–399. doi: 10.1055/a-0582-0122

Consensus-based Recommendation 8.E20
In the event of the lethal triad consisting of persistent haemorrhage, haemorrhagic shock und coagulopathy, the following three-stage approach is recommended 62 : Early surgical haemostasis carried out by the attending surgical obstetrician using a Pfannenstiel incision or median laparotomy, eventeration of the uterus with cranial traction and uterine compression, and atraumatic clamping of the uterine arteries to minimise perfusion. Placement of uterine compression sutures and application of a uterine tamponade. Parallel correction of hypovolaemia, temperature, disturbed acid-base balance and coagulopathy by the anaesthesiologist; if possible, surgery should then be paused until stabilisation. Definitive (surgical) treatment of the now haemodynamically stable patient by a surgeon with the appropriate surgical expertise. If the necessary infrastructure is available, option to perform interventional radiological embolisation of afferent uterine arteries 79 , 80 . The benefit of this approach is that it can preserve fertility, as has been described for large case series 81 , 82 , 83 , 84 .

Consensus-based Recommendation 8.E20

Expert consensus

Level of consensus ++

In the event of the lethal triad consisting of persistent haemorrhage, haemorrhagic shock und coagulopathy, the following three-stage approach is recommended 62 :

Early surgical haemostasis carried out by the attending surgical obstetrician using a Pfannenstiel incision or median laparotomy, eventeration of the uterus with cranial traction and uterine compression, and atraumatic clamping of the uterine arteries to minimise perfusion. Placement of uterine compression sutures and application of a uterine tamponade.
Parallel correction of hypovolaemia, temperature, disturbed acid-base balance and coagulopathy by the anaesthesiologist; if possible, surgery should then be paused until stabilisation.
Definitive (surgical) treatment of the now haemodynamically stable patient by a surgeon with the appropriate surgical expertise. If the necessary infrastructure is available, option to perform interventional radiological embolisation of afferent uterine arteries 79 , 80 . The benefit of this approach is that it can preserve fertility, as has been described for large case series 81 , 82 , 83 , 84 .