关键词: 剖宫产术, 产后出血, 止血, 手术, 子宫切除术, 宫腔填纱术

Abstract: Objective：To investigate the efficacy of different hemostatic surgeries to control severe postpartum hemorrhage following cesarean section and analyze the reason for homeostasis failure. Methods：135 cases with severe postpartum hemorrhage following cesarean section were randomly divided into improved uterine compression sutures group（65 cases） and uterine gauze packing group（70 cases）. The operating time，intraoperative and postoperative bleeding，hemostatic success rate，hysterectomy rate and complication rate were compared between two groups. Results：The operating time and intraoperative bleeding of improved uterine compression sutures group were significantly lower than those of uterine gauze packing group（P＜0.05）. There were not significant differences in hemostatic success rate，postoperative bleeding and hysterectomy rate between the two groups（all P＞0.05）. The hemostatic success rate of patients with placental disorders including placenta previa, placenta accrete in improved uterine compression sutures group was significantly lower than that in uterine gauze packing group （P＜0.05），while the hemostatic success rate of patients with excessive uterine stretch factor was significantly higher than that in uterine gauze packing group（P＜0.05）. There were no significant difference in the incidence of lochia time after surgery, time of menstruation turn over and menstruation reduction, dysmenorrheal, intrauterine adhesion and obstetric infection between the two groups（all P＞0.05）. Conclusions：Improved uterine compression sutures had such advantages as less bleeding，shorter operating time and higher success rate in excessive uterine stretch factor inducing bleeding. The uterine gauze packing has better hemostatic effect for placental factors inducing hemorrhage. Clinical treatment should be individualized.

Key words: Cesarean section, Postpartum hemorrhage, Hemostasis, surgical, Hysterectomy, Uterine compression sutures