Surgical intervention in the management of postpartum hemorrhage.

Obstetric hemorrhage is often a sudden, life-threatening event. Successful management hinges on both preoperative preparation if hemorrhage is anticipated as well as knowledge of interventions. Uterine-sparing techniques, such as aggressive and early use of uterotonics, balloon tamponade, uterine compression sutures, arterial ligation, and selective arterial embolization, may be used to control hemorrhage. If these techniques are not adequate, the decision must be made to proceed with hysterectomy. The type of hysterectomy (subtotal vs. total) must be individualized to each patient. Hemostatic agents may be particularly useful in patients who have excessive blood loss from raw tissue surfaces.