To explore the therapeutic effects of surgical treatment for patients with refractory postpartum hemorrhage (IPPH) after cesarean sections.

Clinical research literature on the efficacy of surgical treatment for patients with IPPH after cesarean section was selected from databases including China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP Chinese Journal Service Platform, China Biomedical Literature Database, PubMed, Embase, and Web of Science using computer-based retrieval. Key words in both Chinese and English, such as ＂cesarean section＂ ＂refractory postpartum hemorrhage＂ etc., were employed to screen clinical studies that met the inclusion and exclusion criteria of this research and had acceptable literature quality. The retrieval time frame was from January 1, 2000, to June 1, 2024. RevMan 5.3 software was used to analyze the obtained data. First, the Cochrane-Q test was applied to detect the heterogeneity among the included literature, and a random effects model or a fixed effects model was used for Meta-analysis based on the results. For the efficacy evaluation index postpartum hemorrhage(PPH) volume adopted in this study, the standardized mean difference (SMD) was used as the effect size, and its 95%CI was calculated. A funnel plot was used to evaluate the publication bias of the included literature.

According to the literature retrieval strategy set in this study, a total of 17 pieces of literature on the efficacy of surgical treatment for patients with IPPH after cesarean section were included, all of which were of grade B quality. There was significant heterogeneity among the literature. The studies involved 775 patients with IPPH after cesarean section treated surgically, and a total of eight surgical treatment methods were adopted. The SMD with PPH volume as the efficacy index for 8 methods were as follows, respectively. The SMD for the efficacy of modified B-Lynch suture combined with bilateral ascending uterine artery ligation was -2.07 (95%CI: -3.14--1.00, P<0.001); the SMD for the efficacy of modified B-Lynch suture was -0.59 (95%CI: -0.84--0.34, P<0.001); the SMD for the efficacy of bilateral ascending uterine artery ligation was -2.77 (95%CI: -4.91--0.64, P<0.001); the SMD for the efficacy of uterine artery ligation combined with intrauterine water balloon compression was -1.27 (95%CI: -1.76--0.77, P<0.001); the SMD for the efficacy of uterine artery ligation combined with Hayman suture was -5.24 (95%CI: -6.01--4.48, P<0.001); the SMD for the efficacy of Bakri balloon intrauterine packing was -3.71 (95%CI: -4.77--2.65, P<0.001); the SMD for the efficacy of pelvic vascular interventional embolization was -1.63 (95%CI: -1.92--1.34, P<0.001); and the SMD for the efficacy of uterine cross-ligature was -4.52 (95%CI: -11.26--2.22, P=0.190). The pooled effect size for the efficacy of the eight surgical treatment methods, that is, the overall SMD for efficacy was -2.46 (95%CI: -3.09--1.82, P<0.001). The efficacy of the study group (use one of the eight methods) was superior to that of the control group, and the differences were all statistically significant (P<0.05).

The existing eight surgical treatment methods, such as modified B-Lynch suture etc., have definite clinical efficacy in treating patients with IPPH after cesarean section and can be selected for individual or combined application according to the actual conditions of patients.