{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T05:46:50Z","timestamp":1782539210324,"version":"3.54.5"},"reference-count":40,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, accounting for approximately 27% of maternal deaths. In Spain, its incidence ranges from 2.5% to 5.2%. Clinical management has evolved toward a stepwise approach integrating pharmacological, mechanical, and surgical interventions. This study aims to analyze the evolution of these techniques during the 2020\u20132024 period to optimize decision-making and maternal outcomes. Methods: A systematic review was conducted following the PRISMA 2020 guidelines. Comprehensive searches were performed in PubMed, Scopus, and the Cochrane Library for studies published between 2020 and 2024 in English and Spanish. The PICO framework was utilized to evaluate interventions including intrauterine balloon tamponade (UBT), compression sutures, and arterial embolization, prioritizing outcomes such as bleeding control and fertility preservation. Out of 34 identified records, 13 studies met the final inclusion criteria. Results: The findings demonstrate a clear trend toward conservative management. Intrauterine balloon tamponade reported success rates of 80\u201390% in controlling refractory bleeding and significantly reduced the hysterectomy rates. B-Lynch compression sutures showed success rates between 68.4% and 100%, with generally favorable fertility outcomes. However, combining these sutures with devascularization increased the risk of uterine necrosis. Additionally, the early administration of tranexamic acid (TXA) within 3 h of birth was confirmed as a critical factor in reducing mortality. Conclusions: Acute PPH management has shifted toward protocol-based, sequential, and less invasive strategies. The implementation of standardized algorithms, care bundles, and simulation-based training is essential to reduce decision inertia and improve obstetric safety. While conservative mechanical and surgical techniques are effective, institutional protocols must be regularly updated to consolidate these technological and organizational advances.<\/jats:p>","DOI":"10.3390\/life16061030","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T14:37:42Z","timestamp":1781879862000},"page":"1030","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving Obstetric Safety in Postpartum Hemorrhage: Impact of Protocol-Based Conservative Management"],"prefix":"10.3390","volume":"16","author":[{"given":"Martina Cheli","family":"Basurte","sequence":"first","affiliation":[{"name":"Department of Surgical Specialties, Biochemistry and Immunology, University of Malaga, 29010 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1199-5459","authenticated-orcid":false,"given":"Marta","family":"Blasco Alonso","sequence":"additional","affiliation":[{"name":"Department of Surgical Specialties, Biochemistry and Immunology, University of Malaga, 29010 Malaga, Spain"},{"name":"Obstetrics and Gynecology Department, Hospital Materno-Infantil, Hospital Regional Universitario Malaga, Avenida Arroyo de los Angeles S\/N, 29011 Malaga, Spain"},{"name":"Research Group in Maternal-Fetal Medicine Epigenetics Women\u2019s Diseases and Reproductive Health, Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9148-9881","authenticated-orcid":false,"given":"Isidoro","family":"Narbona Arias","sequence":"additional","affiliation":[{"name":"Department of Surgical Specialties, Biochemistry and Immunology, University of Malaga, 29010 Malaga, Spain"},{"name":"Obstetrics and Gynecology Department, Hospital Materno-Infantil, Hospital Regional Universitario Malaga, Avenida Arroyo de los Angeles S\/N, 29011 Malaga, Spain"},{"name":"Research Group in Maternal-Fetal Medicine Epigenetics Women\u2019s Diseases and Reproductive Health, Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6577-0557","authenticated-orcid":false,"given":"Lorena","family":"Sabonet Moriente","sequence":"additional","affiliation":[{"name":"Department of Surgical Specialties, Biochemistry and Immunology, University of Malaga, 29010 Malaga, Spain"},{"name":"Obstetrics and Gynecology Department, Hospital Materno-Infantil, Hospital Regional Universitario Malaga, Avenida Arroyo de los Angeles S\/N, 29011 Malaga, Spain"},{"name":"Research Group in Maternal-Fetal Medicine Epigenetics Women\u2019s Diseases and Reproductive Health, Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Mart\u00ednez Diez","sequence":"additional","affiliation":[{"name":"Department of Surgical Specialties, Biochemistry and Immunology, University of Malaga, 29010 Malaga, Spain"},{"name":"Obstetrics and Gynecology Department, Hospital Materno-Infantil, Hospital Regional Universitario Malaga, Avenida Arroyo de los Angeles S\/N, 29011 Malaga, Spain"},{"name":"Research Group in Maternal-Fetal Medicine Epigenetics Women\u2019s Diseases and Reproductive Health, Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7286-8656","authenticated-orcid":false,"given":"Jesus S.","family":"Jimenez Lopez","sequence":"additional","affiliation":[{"name":"Department of Surgical Specialties, Biochemistry and Immunology, University of Malaga, 29010 Malaga, Spain"},{"name":"Obstetrics and Gynecology Department, Hospital Materno-Infantil, Hospital Regional Universitario Malaga, Avenida Arroyo de los Angeles S\/N, 29011 Malaga, Spain"},{"name":"Research Group in Maternal-Fetal Medicine Epigenetics Women\u2019s Diseases and Reproductive Health, Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Abdulsalam, F.A.M., Bourdakos, N.E., Burns, J.W.F., Zervides, Z.Y., Yap, N.Q.E., Adra, M., Nakanishi, H., Than, C.A., Chervenak, F.A., and Arulkumaran, S.S. (2024). Twin pregnancy and postpartum haemorrhage: A systematic review and meta-analysis. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06798-0"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s42155-024-00429-7","article-title":"Primary and secondary postpartum haemorrhage: A rationale endovascular approach","volume":"7","author":"Gallardo","year":"2024","journal-title":"CVIR Endovasc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/AOG.0000000000005662","article-title":"Prophylactic radiologic interventions for postpartum hemorrhage control in placenta accreta spectrum","volume":"144","author":"Bonsen","year":"2024","journal-title":"Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101049","DOI":"10.1016\/j.ajogmf.2023.101049","article-title":"Tranexamic acid for reducing blood loss after cesarean section","volume":"5","author":"Cheema","year":"2023","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/AOG.0000000000004228","article-title":"Risk factors for atonic postpartum hemorrhage","volume":"137","author":"Ende","year":"2021","journal-title":"Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"38","DOI":"10.5603\/GP.2020.0009","article-title":"Epidemiology, prevention and management of early postpartum hemorrhage","volume":"91","author":"Feduniw","year":"2020","journal-title":"Ginekol. Pol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"FIGO Safe Motherhood and Newborn Health Committee (2012). FIGO guidelines: Prevention and treatment of postpartum hemorrhage. Int. J. Gynaecol. Obstet., 117, 108\u2013118.","DOI":"10.1016\/j.ijgo.2012.03.001"},{"key":"ref_8","first-page":"CD011689","article-title":"Uterotonic agents for preventing postpartum haemorrhage","volume":"4","author":"Gallos","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","first-page":"CD016147","article-title":"Uterotonics for management of retained placenta","volume":"10","author":"Sothornwit","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s12978-023-01657-1","article-title":"Novel concepts for treating postpartum haemorrhage","volume":"20","author":"Hofmeyr","year":"2023","journal-title":"Reprod. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.ajog.2021.08.060","article-title":"Preventing postpartum hemorrhage after cesarean delivery","volume":"226","author":"Jaffer","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13017-024-00556-5","article-title":"Outcomes and prognosis of postpartum hemorrhage","volume":"19","author":"Jung","year":"2024","journal-title":"World J. Emerg. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1007\/s00404-014-3511-2","article-title":"B-Lynch uterine compression sutures","volume":"291","author":"Kaya","year":"2015","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1016\/S0140-6736(24)02102-0","article-title":"Tranexamic acid for postpartum bleeding","volume":"404","author":"Ker","year":"2024","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.bpa.2022.02.004","article-title":"Latest advances in postpartum hemorrhage management","volume":"36","author":"Kumaraswami","year":"2022","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.gyobfe.2015.06.003","article-title":"Devenir obst\u00e9trical apr\u00e8s plicatures ut\u00e9rines dans le traitement de l\u2019h\u00e9morragie de la d\u00e9livrance: Suivi \u00e0 long terme de 40 cas [Obstetric outcomes after uterine compression suture for treatment of postpartum hemorrhage: Long-term monitoring of 40 cases]","volume":"43","author":"Loaec","year":"2015","journal-title":"Gynecol. Obstet. Fertil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3000605211010730","DOI":"10.1177\/03000605211010730","article-title":"Uterine necrosis, infection, and subinvolution: Complications observed after combined application of modified B-Lynch suture and vascular ligation","volume":"49","author":"UtLuo","year":"2021","journal-title":"J. Int. Med. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1182\/hematology.2020000139","article-title":"Hematological aspects of postpartum hemorrhage","volume":"2020","author":"McLintock","year":"2020","journal-title":"Hematol. Am. Soc. Hematol. Educ. Program"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"10416","DOI":"10.1080\/14767058.2022.2128659","article-title":"Postpartum hemorrhage drills or simulations and adverse outcomes: A systematic review and Bayesian meta-analysis","volume":"35","author":"Bell","year":"2022","journal-title":"J. Matern Fetal Neonatal Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12978-022-01360-7","article-title":"Magnitude of postpartum hemorrhage and its associated factors in Ethiopia: A systematic review and meta-analysis","volume":"19","author":"Nigussie","year":"2022","journal-title":"Reprod. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"120058","DOI":"10.1016\/j.carbpol.2022.120058","article-title":"Advances in chitosan-based wound dressings: Modifications, fabrications, applications and prospects","volume":"297","author":"Ji","year":"2022","journal-title":"Carbohydr. Polym."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1080\/17434440.2021.1962288","article-title":"Profile of the Jada\u00ae System: The vacuum-induced hemorrhage control device for treating abnormal postpartum uterine bleeding and postpartum hemorrhage","volume":"18","author":"Rood","year":"2021","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2451658","DOI":"10.1080\/14767058.2025.2451658","article-title":"Real-world use of a vacuum-induced hemorrhage-control device in births <34 weeks gestational age","volume":"38","author":"Rood","year":"2025","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2565","DOI":"10.1111\/jog.14834","article-title":"Prenatal anemia and postpartum hemorrhage risk: A systematic review and meta-analysis","volume":"47","author":"Omotayo","year":"2021","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_25","first-page":"17455057231225311","article-title":"Prophylactic tranexamic acid for reducing intraoperative blood loss during cesarean section in women at high risk of postpartum hemorrhage: A double-blind placebo randomized controlled trial","volume":"20","author":"Ortuanya","year":"2024","journal-title":"Womens Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_27","first-page":"CD012754","article-title":"Uterotonic agents for first-line treatment of postpartum haemorrhage: A network meta-analysis","volume":"11","author":"Papadopoulou","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1093\/bja\/aeu448","article-title":"Tranexamic acid for the prevention and treatment of postpartum haemorrhage","volume":"114","author":"Sentilhes","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"863.e1","DOI":"10.1016\/j.fertnstert.2008.09.082","article-title":"Fertility after B-Lynch","volume":"91","author":"Sentilhes","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1111\/aogs.14795","article-title":"PPH and postpartum depression","volume":"103","author":"Sheng","year":"2024","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"293.e1","DOI":"10.1016\/j.ajog.2019.11.1287","article-title":"Uterine balloon tamponade for the treatment of postpartum hemorrhage: A systematic review and meta-analysis","volume":"222","author":"Suarez","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/j.1471-0528.2012.03454.x","article-title":"Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: A systematic review","volume":"120","author":"Tindell","year":"2013","journal-title":"BJOG"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.ajog.2024.01.012","article-title":"Effectiveness of care bundles for prevention and treatment of postpartum hemorrhage: A systematic review","volume":"231","author":"Vogel","year":"2024","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/FM9.0000000000000261","article-title":"Postpartum Hemorrhage","volume":"7","author":"Wang","year":"2025","journal-title":"Matern Fetal Med."},{"key":"ref_35","unstructured":"WHO (2017). Recommendations for PPH, WHO."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1016\/S0140-6736(25)00448-9","article-title":"Causes of and risk factors for postpartum haemorrhage: A systematic review and meta-analysis","volume":"405","author":"Yunas","year":"2025","journal-title":"Lancet"},{"key":"ref_37","first-page":"CD016278","article-title":"Tranexamic acid for preventing postpartum haemorrhage after caesarean section","volume":"11","author":"Rohwer","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1097\/AOG.0000000000004674","article-title":"World Health Organization Recommendation for Using Uterine Balloon Tamponade to Treat Postpartum Hemorrhage","volume":"139","author":"Weeks","year":"2022","journal-title":"Obstet. Gynecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.bpobgyn.2019.04.005","article-title":"Tranexamic acid for post-partum haemorrhage: What, who and when","volume":"61","author":"Brenner","year":"2019","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S1076","DOI":"10.1016\/j.ajog.2023.08.015","article-title":"Intrauterine devices in the management of postpartum hemorrhage","volume":"230","author":"Overton","year":"2024","journal-title":"Am. J. Obstet. Gynecol."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/6\/1030\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T05:06:14Z","timestamp":1782536774000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/6\/1030"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["life16061030"],"URL":"https:\/\/doi.org\/10.3390\/life16061030","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]}}}