Severe sepsis is a common, expensive, and frequently fatal syndrome in critically ill surgical patients in China. Other than the microbiological patterns, the incidence, mortality, and major characteristics of severe sepsis in Chinese surgical intensive care units are close to those documented in developed countries.

Peripartum hysterectomy can be required to control persistent postpartum haemorrhage. This audit aimed to review the incidence, management and outcomes of women undergoing peripartum hysterectomy. This was a retrospective audit of women undergoing peripartum hysterectomy at the Simpson Centre of Reproductive Health, Edinburgh, over an 8-year period from 2002 to 2010. Peripartum hysterectomy was defined as hysterectomy performed following delivery of a fetus and categorised as primary or secondary. There were no maternal deaths and the rate of peripartum hysterectomy was 5.9 per 10 000 deliveries. 26 of the 28 patients delivered the index pregnancy by caesarean section. The most common reasons for obstetric haemorrhage were abnormal placental site and adherence and uterine atony. All 16 placenta praevia were identified antenatally and ten required emergency caesarean section due to significant antepartum haemorrhage. Only 11 patients received documented counselling on the possibility of hysterectomy. These women all had a placental abnormality diagnosed antenatally. Patients with documented uterine atony received at least two uterotonics. Uterotonics were given less frequently in patients with placental problems. Fifty percent of patients suffered at least one post-operative complication. Two patients received ICU care and all patients spent time in HDU. All patients received appropriate thromboprophylaxis. Fetal outcomes were good. The rate of peripartum hysterectomy was slightly higher than the national average (4.1%) and included one secondary peripartum hysterectomy. This audit highlights many important learning points. Counselling for women undergoing caesarean section with anticipated major obstetric haemorrhage should include the documented possibility of hysterectomy and post-operative complications.

Objective In view of the current clinical inaccuracies and underestimations of postpartum hemorrhage amount, this study aims to investigate the incidence, etiology, clinical characteristics of postpartum hemorrhage in different modes of delivery based on the combination of volumetric method, gravimetric method and area method in evaluating blood loss. Design This retrospective cohort study was conducted in Hangzhou Women’s Hospital from January 2020 to June 2021, including 725 cases of postpartum hemorrhage among 18,977 parturients. Based on different modes of delivery, the participants were divided into three groups: vaginal delivery, forceps delivery, and cesarean section, for comparison. Methods Using an improved combined assessment method for blood loss, we retrospectively analyzed a cohort of parturients with postpartum hemorrhage who underwent vaginal delivery, forceps delivery, or cesarean section and were hospitalized in Hangzhou Women’s Hospital from January 2020 to June 2021. Results (1) Among the 18,977 parturients, 725 cases of postpartum hemorrhage occurred, with an incidence rate of 3.8%, and severe postpartum hemorrhage accounted for 0.4% of the cases. (2) The incidence of postpartum hemorrhage was significantly higher in the forceps delivery group than in the vaginal delivery group (χ2 = 19.27, P<0.001), while the incidence of severe postpartum hemorrhage was significantly higher in the cesarean section group than in the vaginal delivery group (χ2 = 8.71, P = 0.003). (3) The causes of postpartum hemorrhage were statistically different among the different delivery modes, with varying underlying factors (P<0.001). (4) Patients with postpartum hemorrhage in different delivery modes showed statistically significant differences in age, body mass index (BMI), birth weight, gestational age, gravidity, parity, the decline of postpartum peripheral blood hemoglobin concentration, and estimated blood loss (P<0.05). (5) The proportion of blood transfusion was significantly higher in the cesarean section group than in the vaginal delivery and forceps delivery groups (χ2 = 231.03, P<0.001). Limitations This study is a single-center retrospective study, which may have led to selection bias in case selection. Additionally, the implementation of the combined three blood loss assessment methods may not have been strictly followed in all cases. Moreover, due to the mixing of bleeding with amniotic and irrigation fluids, the accuracy of evaluation may have been affected, leading to the possibility of inaccuracy of blood loss. Conclusions Forceps delivery and cesarean section increase the risk of postpartum hemorrhage, but forceps delivery does not significantly increase the incidence of severe postpartum hemorrhage. Uterine atony remains the leading cause of postpartum hemorrhage, while birth canal laceration and placental factors are the second most common causes of postpartum hemorrhage in forceps delivery and cesarean section, respectively. In this study, the volumetric method, gravimetric method and area method were combined to quantitatively assess postpartum hemorrhage amount. The combined method has strong clinical practicability and is less affected by subjective factors, although it also has limitations. In the future, we still need to focus on the early prediction and identification of postpartum hemorrhage, and further improve the quantitative assessment of postpartum blood loss.