Methods of compression hemostasis in the management of postpartum hemorrhage

Artymuk N.V., Marochko T.Yu., Apresyan S.V., Artymuk D.A.

1) Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo, Russia; 2) Peoples’ Friendship University of Russia, Moscow, Russia

The incidence of postpartum hemorrhage (PPH) in the world is currently about 5% and has no tendency to decrease. Most maternal deaths associated with PPH are preventable. The patients respond appropriately to first-line treatments for PPH, which include uterotonics, uterine massage, and tranexamic acid; however, 10–20% of these patients remain refractory and require the use of second-line interventions. In case of severe refractory PPH, the patient often undergoes an emergency hysterectomy, which leads to loss of reproductive and menstrual functions, but to date it remains an urgent surgical intervention aimed at saving the life of a mother with uncontrolled bleeding.
The article presents the historical aspects of the problem and overview of the current data on the management of refractory PPH with the use of compression methods, including compression measures (compression of the aorta or bimanual compression of the uterus), intrauterine balloon tamponade, endovascular methods (temporary balloon occlusion and embolization), ligation and temporary vascular occlusion using tourniquet hemostasis. Each of the methods has indications, contraindications, conditions, limitations, complications and effectiveness. The choice of the hemostasis method is known to depend on the preferences of the surgeon and the equipment of the clinics. Each of these methods can be used alone or in combination with other methods. However, conservative measures for preserving the uterus are acceptable only in a situation of hemodynamic stability of the patient when there is no life-threatening bleeding.
Conclusion: The problem of management of refractory PPH continues to be relevant at the present time. Various methods of compression hemostasis have been approved and they are successfully used alone or in combination with each other. However, there is a lack of data on their most rational sequence, combination with each other and with other methods. It is necessary to continue research in this direction.

Authors’ contributions: Artymuk N.V., Apresyan S.V. – developing the concept and design of the study; Artymuk D.A., Artymuk N.V., Marochko T.Yu. – search and analysis of the material; Artymuk D.A., Marochko T.Yu., Apresyan S.V. – writing the text; Artymuk N.V., Apresyan S.V. – editing the text.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
For citation: Artymuk N.V., Marochko T.Yu., Apresyan S.V., Artymuk D.A.
Methods of compression hemostasis in the management of postpartum hemorrhage.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (12): 16-24 (in Russian)


postpartum hemorrhage
complex compression hemostasis
controlled balloon tamponade
compression suture
uterine artery embolization
uterine vascular ligation


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Received 28.08.2023

Accepted 16.11.2023

About the Authors

Natalya V. Artymuk, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology named after Prof. G.A. Ushakova, Kemerovo State Medical University, Ministry of Health of the Russian Federation, +7(3842)73-48-56, +7(960)923-33-55,,,
650056, Russia, Kemerovo, Voroshilova str., 22a.
Tatyana Yu. Marochko, PhD, Associate Professor of the Department of Obstetrics and Gynecology named after Prof. G.A. Ushakova, Kemerovo State Medical University, Ministry of Health of the Russian Federation,,, 650060, Russia, Kemerovo, Voroshilova str., 22a.
Sergey V. Apresyan, Dr. Med. Sci., Professor of the Department of Obstetrics and Gynecology, Patrice Lumumba Peoples’ Friendship University of Russia,,, 117198, Russia, Moscow, Miklukho-Maklay str., 6.
Dmitry A. Artymuk, clinical resident of the Department of Obstetrics and Gynecology, Patrice Lumumba Peoples’ Friendship University of Russia,,, 117198, Russia, Moscow, Miklukho-Maklay str., 6.
Corresponding author: Natalya V. Artymuk,

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