No standard treatment guidelines have been established for postpartum hemorrhage (PPH). We aimed to assess the differences in outcomes and prognoses between patients with PPH who underwent surgical and non-surgical treatment. This retrospective study included 230 patients diagnosed with PPH at two referral hospitals between August 2013 and October 2023. The patients were divided into non-surgical (group 1, n = 159) and surgical intervention groups (group 2, n = 71). A subgroup analysis was performed by dividing the surgical intervention group into immediate (n = 45) and delayed surgical intervention groups (n = 26). Initial lactic acid levels and shock index were significantly higher in group 2 (2.85 ± 1.37 vs. 4.54 ± 3.63 mmol/L, p = 0.001, and 0.83 ± 0.26 vs. 1.10 ± 0.51, p < 0.001, respectively). Conversely, initial heart rate and body temperature were significantly lower in group 2 (92.5 ± 21.0 vs. 109.0 ± 28.1 beat/min, p < 0.001, and 37.3 ± 0.8 °C vs. 37.0 ± 0.9 °C, p = 0.011, respectively). Logistic regression analysis identified low initial body temperature, high lactic acid level, and shock index as independent predictors of surgical intervention (p = 0.029, p = 0.027, and p = 0.049, respectively). Regarding the causes of PPH, tone was significantly more prevalent in group 1 (57.2% vs. 35.2%, p = 0.002), whereas trauma was significantly more prevalent in group 2 (24.5% vs. 39.4%, p = 0.030). Group 2 had worse overall outcomes and prognoses than group 1. The subgroup analysis showed significantly higher rates of uterine atony combined with other causes, hysterectomy, and disseminated intravascular coagulopathy in the delayed surgical intervention group than the immediate surgical intervention group (42.2% vs. 69.2%, p = 0.027; 51.1% vs. 73.1%, p = 0.049; and 17.8% vs. 46.2%, p = 0.018, respectively). Patients with PPH presenting with increased lactic acid levels and shock index and decreased body temperature may be surgical candidates. Additionally, immediate surgical intervention in patients with uterine atony combined with other causes of PPH could improve prognosis and reduce postoperative complications.

中文翻译：

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根据管理方案的产后出血结局和预后： 来自两个转诊中心的 11 年回顾性研究


尚未建立产后出血 （PPH） 的标准治疗指南。我们旨在评估接受手术和非手术治疗的 PPH 患者之间结局和预后的差异。这项回顾性研究包括 2013 年 8 月至 2023 年 10 月期间在两家转诊医院诊断为 PPH 的 230 名患者。将患者分为非手术组 （第 1 组，n = 159） 和手术干预组 （第 2 组，n = 71）。通过将手术干预组分为立即 （n = 45） 和延迟手术干预组 （n = 26） 进行亚组分析。第 2 组的初始乳酸水平和休克指数显著升高 （分别为 2.85 ± 1.37 vs. 4.54 ± 3.63 mmol/L，p = 0.001 和 0.83 ± 0.26 vs. 1.10 ± 0.51，p < 0.001）。相反，第 2 组的初始心率和体温显着降低 （92.5 ± 21.0 vs. 109.0 ± 28.1 次/分钟，p < 0.001 和 37.3 ± 0.8 °C vs. 37.0 ± 0.9 °C，p = 0.011，分别为）。Logistic 回归分析发现，低初始体温、高乳酸水平和休克指数是手术干预的独立预测因子 （分别为 p = 0.029 、 p = 0.027 和 p = 0.049）。关于 PPH 的原因，第 1 组肌张力明显更普遍 （57.2% vs. 35.2%，p = 0.002），而创伤在第 2 组明显更普遍 （24.5% vs. 39.4%，p = 0.030）。第 2 组的总体结局和预后比第 1 组差。亚组分析显示，延迟手术干预组子宫乏力合并其他原因、子宫切除术和弥散性血管内凝血病的发生率显著高于即刻手术干预组 （42.2% vs. 69.2%，p = 0.027;51.1% vs. 73.1%，p = 0。049;和 17.8% 对 46.2%，分别为 p = 0.018）。表现为乳酸水平和休克指数升高以及体温降低的 PPH 患者可能适合手术。此外，子宫收缩乏力合并其他原因的 PPH 患者立即手术干预可改善预后并减少术后并发症。