Clinical analysis of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.

Objective This study was performed to explore the causes and clinical characteristics of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage. Methods This retrospective study was performed from January 2004 to December 2017. Patients with intractable postpartum hemorrhage were grouped according to the initial pathogenesis as determined by exploratory laparotomy: uterine atony, placental factors, coagulation dysfunction, or uterine rupture. Results This study involved 72 patients who underwent emergency exploratory laparotomy, accounting for 0.04% of total deliveries. Uterine preservation surgery and hysterectomy were performed in 31 and 41 patients, respectively. Abnormal events upon returning to the ward were primarily vaginal hemorrhage and pelvic hematoma. The frequency of uterine artery ligation was lower in the hysterectomy group than uterine preservation group. The prothrombin activity level, fibrinogen level, and platelet count before surgery were lower in the hysterectomy group than uterine preservation group. The international normalized ratio and activated partial thromboplastin time were higher in the hysterectomy group than uterine preservation group. In total, 44 patients developed complications. Conclusion Placental implantation is a primary cause of hysterectomy after emergency laparotomy. However, the possibility of postpartum hemorrhage caused by coagulation disorders should not be ignored.