Role of PPH clamp as a first aid PPH management in central India population

The maternal mortality rate (MMR) is often used as an indicator of healthcare quality. Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, resulting from uncontrolled bleeding and accounting for nearly 30% of maternal deaths. About two-thirds of obstetric morbidity is associated with hemorrhage. Research has indicated that PPH increases the risk of morbidity by 50 times compared to mortality, which is five times higher.

The goal of a prospective cohort study was to assess the utility of PPH clamp/forceps as a first aid in PPH management. Additional objectives of this study were to study the role of PPH clamp in:

• Excessive bleeding prevention following delivery.
• Maternal death prevention in hospitals and low-resource healthcare centers. 
• In reducing the need for blood transfusion and surgical intervention. 
• To study the association of parity status and PPH.
• To study the efficiency and time responsiveness of the interventions used in PPH prevention.

This study was conducted over one year at the Department of Obstetrics & Gynaecology of MGM Medical College and M.Y. Hospital, Indore. 

The study involved 60 patients. Those who developed PPH despite failed medical management and provided consent for clamp application were included, while those with cervical cancer or without consent were excluded.

The results revealed that more than half (56.7%) of the clamping procedures were successful. Patients with lower parity had greater chances of successful clamp application. Further, cases with successful clamping encountered significantly less blood loss than those without successful clamping. Furthermore, majority of the patients with successful clamp application did not require additional surgical interventions, in contrast to those without successful clamping, where blood loss was significantly greater.

Further, successful clamping was more common in patients aged 20-25 years and those with lower socioeconomic status. Patients with lower parity were more likely to have successful clamping, with second parity being the most common. The regularity of menstrual cycles did not influence clamp success. Patients with successful clamping had lower mean hemoglobin (Hb) and prothrombin time international normalized ratio (PTINR) values. Blood products (PRP, FFP, PCV) were used significantly less among those with successful clamping. The presence of hypertension or hypotension did not differ substantially with the clamp application. Most patients with successful clamping underwent normal vaginal delivery, and the majority did not require surgical procedures, unlike those without successful clamping.

Source: Soni K, Singh K, Golhani P. Indian J Obstet Gynecol Res. 2023;10(3):278-284