Published: 2018-07-26

Paracervical clamps for treatment of uncontrolled postpartum haemorrhage: a novel technique

Ramalingappa C. A., Durga Sireesha U., Shruthi B.


Background: PPH is one of the most dreaded third stage complication and is one of the leading cause of maternal mortality and morbidity. Most of the deaths are due to limited availability of pharmacological agents and absent skills to manage PPH. The basis of the study is to introduce a novel technique of application of paracervical clamps transvaginally for temporary occlusion of uterine arteries which represent 90% of blood flow to the uterus.

Methods: A prospective study of patients with PPH who did not respond to medical management and who were hemodynamically stable. Paracervical clamps were applied and hemodynamic parameters are continuously monitored. Close monitoring for bleeding PV is done. Clamps are left intact for 6-8 hours and removed.

Results: Out of 680 cases of Post-partum haemorrhage. Paracervical clamps were applied to 320 patients from duration of 2013 to 2015 in Karnataka Institute of Medical Sciences and Sushruta Multispeciality Hospital Hubballi. Haemorrhage was effectively controlled in 304 (95.1%) patients and only 16 patients required further surgical management. This non-invasive simple procedure has reduced the rates of surgical management of PPH and the associated morbidity.

Conclusions: Application of paracervical clamps is an effective, simple and minimally invasive surgical technique for avoiding excess blood loss in mild to moderate postpartum haemorrhage.


Conservative management, Paracervical clamps, PPH

Full Text:



World Health Organization. Trends in maternal mortality: 1990-2015: estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary.

Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Practice Res Clin Obstet Gynaecol. 2008;22(6):999-1012.

Society of Obstetricians and Gynaecologists of Canada. Advances in labour and risk management (ALARM) course manual. 9th ed. Ottawa, Ontario: Society of Obstetricians and Gynaecologists of Canada; 2002.

Weeks A. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next? BJOG. 2015;122(2):202-10.

B-Lynch C. Conservative surgical management. A Text Book of Postpartum Hemmorhage. 1st ed. UK: Sapiens; 2006;287:298.

Gai MY, Wu LF, Su QF, Tatsumoto K. Clinical observation of blood loss reduced by tranexamic acid during and after caesarian section: a multi-center, randomized trial. Eu J Obstet Gynecol Reprod Biol. 2004;112(2):154-7.

Movafegh A, Eslamian L, Dorabadi A. Effect of intravenous tranexamic acid administration on blood loss during and after cesarean delivery. Int J Gynaecol Obstet Organ Int Fed Gynaecol Obstet. 2011;115:224-6.

Sekhavat L, Tabatabaii A, Dalili M, Farajkhoda T, Tafti AD. Efficacy of tranexamic acid in reducing blood loss after cesarean section. J Maternal-Fetal Neonat Med. 2009 Jan 1;22(1):72-5

Gungorduk K, Yıldırım G, Asıcıoğlu O, Gungorduk OC, Sudolmus S, Ark C. Efficacy of intravenous tranexamic acid in reducing blood loss after elective cesarean section: a prospective, randomized, double-blind, placebo-controlled study. Am J Perinatol. 2011;28:233-40.

Gohel M, Patel P, Gupta A, Desai P. Efficacy of tranexamic acid in decreasing blood loss during and after cesarean section: a randomised case controlled prospective study. J Obstet Gynecol India. 2007;57:227-30.

Al‐Zirqi I, Vangen S, Forsen L, Stray‐Pedersen B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG. 2008;115(10):1265-72.

Bhavana G, Abhishek MV, Mittal S. A study of risk factors of postpartum hemorrhage and indications for caesarean section. Int J Reprod, Contracept, Obstet Gynecol. 2017 Jan 5;5(6).

Mehrabadi A, Hutcheon JA, Lee L, Kramer MS, Liston RM, Joseph KS. Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: a population‐based retrospective cohort study. BJOG. 2013;120(7):853-62.

Knight M. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG. 2007;114(11):1380-7.

Nahar N, Yusuf N, Ashraf F. Role of intrauterine balloon catheter in controlling massive PPH: experience in Rajshahi Medical College Hospital. Orion Med J. 2009;2:682-3.

Tirumuru S, Saba S, Morsi H, Muammar B. Intrauterine balloon tamponade in the management of severe postpartum hemorrhage: A case series from a busy UK district general hospital. OJOG. 2013;3:131-6.

Joshi VM, Otiv SR, Majumder R, Nikam YA, Shrivastava M. Internal iliac artery ligation for arresting postpartum haemorrhage. BJOG: An Int J Obstet Gynaecol. 2007 Mar 1;114(3):356-61.

Bangal V, Kwatra A, Raghav S. Role of internal iliac artery ligation in control of pelvic hemorrhage. Pravara Med Rev. 2009;1(2):23-5.