Published: Dec 25, 2023
  
 
     
 
Keywords:
postpartum hemorrhage (PPH) lower uterine segment atony (LUSA) lower uterine segment compression (LUSC) hypoxic uterine atony 4Ts Plus Model
  
     
 
   
 
 
 
 
 
 
 
 
 
 
 

 

 
   
 
 
 
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    Home / Archives / Vol. 19 No.2 (2566) : July - December 2023 / Academic Article  
 
   
 

"4Ts Plus Model"/ PPH's New Chapter : Lower uterine segment bleeding : overlooked etiology of postpartum hemorrhage
   
 
   
   
     
 
Wanchai Chantrapitak
Department of obstetrics and gynecology, Charoenkrung Pracharak Hospital, Department of medical services, Bangkok Metropolitan Administration (BMA)
Wisude Anansakunwat
Department of obstetrics and gynecology, Charoenkrung Pracharak Hospital, Department of medical services, Bangkok Metropolitan Administration (BMA)
Sukit Sritippayawan
Department of obstetrics and gynecology, Charoenkrung Pracharak Hospital, Department of medical services, Bangkok Metropolitan Administration (BMA)
Sanguan Lojindarat
Department of obstetrics and gynecology, Charoenkrung Pracharak Hospital, Department of medical services, Bangkok Metropolitan Administration (BMA)
Sawittri Suwikrom
Department of obstetrics and gynecology, Charoenkrung Pracharak Hospital, Department of medical services, Bangkok Metropolitan Administration (BMA)
Renu Wattanaluangarun
Labour room, Charoenkrung Pracharak Hospital, Department of medical services, Bangkok Metropolitan Administration (BMA)

Abstract

Background : Post-partum hemorrhage (PPH) is a fatal postpartum complication dreaded by every obstetrician. Despite advances made in the past century in regards of prevention and treatment of PPHs, the prevalence of atonic PPH paradoxically increased during the past couple decades, developed countries included. Studies revealed that lower uterine segment atony or LUSA could lead to PPH via mechanism of uterine hypoxia.  In order to tackle the problem at its root, lower uterine segment compression (LUSC) could be deployed to prevent LUSA and subsequently PPH.


Contemporary mnemonics of 4Ts remind us of possible etiologies of PPH. Nevertheless, it did not encompass the entirety of the various causes. The author proposed an innovative model, aptly named “4Ts Plus Model”, where atony would be further distinguished into flaccid uterine atony and hypoxic uterine atony. The incidence of the latter could be prevented up to 56.5 – 81.3% by LUSC, depending on the compression duration.


Conclusion : With the discovery of LUSA being another cause of PPH, the new 4Ts Plus Model and LUSC offer innovative strategies for treatment of patients with PPHs which could ultimately lead to lower global maternal postpartum mortalities.

  
     
     
 
    How to Cite  
     
  Chantrapitak, W., Anansakunwat , W. ., Sritippayawan , S. ., Lojindarat , S. ., Suwikrom , S. ., & Wattanaluangarun , R. . (2023). "4Ts Plus Model"/ PPH’s New Chapter : Lower uterine segment bleeding : overlooked etiology of postpartum hemorrhage. Journal of Charoenkrung Pracharak Hospital, 19(2), 7–20. Retrieved from https://he02.tci-thaijo.org/index.php/JCP/article/view/263206  
     

 
 
     
     
 
    Issue  
     
  Vol. 19 No. 2 (2566): July - December 2023  

 
 
     
     
 
    Section  
     
  Academic article  

 
 
     
     
     
 

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