Postpartum hemorrhage (PPH) is the main cause of maternal morbidity and mortality. In most cases, PPH is a result of ineffective uterine contraction. Terlipressin contributing to uterine vessel constriction is injected in high-risk patients to reduce the incidence of hypotonic bleeding during cesarean section. However, there are no studies devoted to preventive injection of terlipressin in high-risk patients.

OBJECTIVE

To study the risk factors of obstetric hemorrhage and effect of terlipressin on the incidence and severity of perioperative obstetric hemorrhage.

MATERIAL AND METHODS

A prospective randomized study included 105 women after caesarean section. In the first group (70 women), 0.4 mg of terlipressin was intraoperatively injected into the uterine incision. In the control group (35 patients), terlipressin was not administered.

RESULTS

Three out of 70 (4.3%) patients had blood loss ≥1000 ml after terlipressin injection. In the control group, pathological blood loss occurred in 14 out of 35 (40%) women. Baseline heart rate (HR) and stroke volume (SV) were significant risk factors for obstetric hemorrhage ≥1000 ml. HR increase per a unit of measurement is associated with increase of odds ratio (OR) of bleeding by 21% (p=0.026), SV increase per a unit of measurement — with decrease of OR by 7% (p=0.031). Prognostic formula for bleeding risk assessment in patients not receiving terlipressin includes HR, SV and serum bilirubin measured one hour before surgery. Sensitivity of this model is 85.7%, specificity is 90.6%. AUC=0.915 indicates favorable predictive efficiency of this formula.

CONCLUSION

Terlipressin is effective for preventing pathological perioperative blood loss ≥1000 ml, herewith its intramuscular administration does not affect systemic hemodynamics.