Postpartum Hemorrhage Surgery

SOC → SCF-DBI Logic Translation

Purpose

Postpartum Hemorrhage (PPH) Surgery encompasses emergency operative interventions performed to control severe obstetric bleeding when medical and conservative measures fail or when life-threatening hemorrhage necessitates immediate definitive source control.

These interventions include:

• Examination under anesthesia with clot evacuation
• Uterine exploration
• Compression suture placement (e.g., B-Lynch-type techniques)
• Uterine artery ligation
• Utero-ovarian artery ligation
• Internal iliac artery ligation
• Stepwise uterine devascularization
• Repair of genital tract trauma
• Hysterectomy (subtotal or total)
• Damage-control pelvic packing
• Re-exploration following cesarean delivery

Under SCF-DBI, Postpartum Hemorrhage Surgery is not merely operative hemostasis.

It is restoration of the Maternal Hemostatic Resilience Network (MHRN) through interruption of hemorrhagic collapse and preservation of maternal physiologic reserve.

SOC Definition

Clinical Objective

Perform definitive surgical hemorrhage control to:

• Arrest life-threatening bleeding
• Restore maternal circulation
• Prevent exsanguination
• Reverse shock physiology
• Preserve organ perfusion
• Maintain reproductive potential when feasible
• Reduce maternal morbidity
• Improve survival

Applicable Cohort

Uterine Atony Refractory to Medical Therapy

Examples:

• Persistent hemorrhage despite uterotonics
• Failure of balloon tamponade
• Recurrent bleeding after conservative measures

Obstetric Trauma

Examples:

• Cervical lacerations
• Vaginal lacerations
• Broad ligament hematomas
• Uterine incision extensions

Placental Pathology

Examples:

• Placenta accreta spectrum
• Placenta increta
• Placenta percreta
• Retained placental tissue with hemorrhage

Coagulopathic Hemorrhage

Examples:

• Disseminated intravascular coagulation
• Massive transfusion-associated bleeding
• Consumptive coagulopathy

Catastrophic Obstetric Hemorrhage

Examples:

• Uterine rupture
• Secondary postpartum hemorrhage requiring surgery
• Hemodynamic collapse
• Damage-control obstetric surgery

SCF-DBI Translation

Core Concept

SOC views Postpartum Hemorrhage Surgery as:

Surgical control of severe postpartum bleeding.

SCF-DBI views Postpartum Hemorrhage Surgery as:

Restoration of the Maternal Hemostatic Resilience Network through interruption of hemorrhagic amplification and preservation of maternal adaptive reserve.

The objective extends beyond bleeding control.

The objective is preservation and restoration of:

1. Maternal hemostatic competence
2. Circulatory stability
3. Organ perfusion
4. Coagulation equilibrium
5. Reproductive integrity when feasible
6. Long-term maternal resilience

SCF-DBI Hemorrhagic Failure Architecture

Domain 1

Maternal Hemostatic Resilience Failure

SOC Focus

Control hemorrhage.

SCF-DBI Focus

Interrupt progression from hemorrhage toward multisystem collapse.

Failure Cascade

Obstetric bleeding

↓

Progressive blood loss

↓

Reduced circulating volume

↓

Decreased oxygen delivery

↓

Coagulopathy amplification

↓

Microvascular dysfunction

↓

Organ hypoperfusion

↓

Hemodynamic collapse

↓

Maternal mortality

SCF Classification

Maternal Hemostatic Resilience Failure Syndrome (MHRFS)

A state in which uncontrolled obstetric hemorrhage overwhelms maternal adaptive systems and threatens survival.

Output

Maternal Hemorrhage Severity Score (MHSS)

Domain 2

Hemostatic–Circulatory Rescue Algorithm

Major SCF-DBI Enhancement

Selected Enhancement:

Hemostatic–Circulatory Rescue Algorithm (HCRA)

This becomes the principal SCF-DBI enhancement for Postpartum Hemorrhage Surgery.

Rationale

SOC evaluates:

• Estimated blood loss
• Surgical hemostasis
• Need for hysterectomy
• Transfusion requirements

SCF-DBI evaluates:

Whether surgical intervention restores integrated hemostatic and circulatory resilience.

The central question becomes:

Has operative intervention redirected maternal physiology from hemorrhagic decompensation toward adaptive recovery?

Rescue Failure Cascade

Persistent hemorrhage

↓

Ongoing volume depletion

↓

Consumptive coagulopathy

↓

Escalating transfusion needs

↓

Progressive shock

↓

Organ dysfunction

↓

Maternal deterioration

Rescue Recovery Cascade

Rapid recognition

↓

Massive hemorrhage activation

↓

Definitive surgical control

↓

Hemostatic restoration

↓

Circulatory stabilization

↓

Perfusion recovery

↓

Organ preservation

↓

Maternal survival

Assessment Domains

Rescue States

Output

Hemostatic–Circulatory Rescue Score (HCRS)

Domain 3

Coagulation Intelligence Surveillance

SCF-DBI Enhancement

PPH evolves through dynamic alterations in coagulation physiology.

Assessment Domains

Output

Coagulation Intelligence Score (CIS)

Domain 4

Organ Perfusion Preservation

SCF-DBI Enhancement

The principal threat of severe hemorrhage is global hypoperfusion.

Assessment Domains

Output

Organ Perfusion Score (OPS)

Domain 5

Reproductive Preservation Intelligence

SCF-DBI Enhancement

When feasible, fertility preservation influences long-term maternal outcomes.

Assessment Domains

Preservation States

Output

Reproductive Preservation Score (RPS-PPH)

Domain 6

Maternal Functional Recovery Readiness

SCF-DBI Enhancement

Survival transitions into meaningful maternal recovery.

Assessment Domains

Readiness States

Output

Maternal Recovery Readiness Score (MRRS)

Domain 7

RHENOVA Maternal Hemorrhage Matrix

SCF-DBI Enhancement

The objective is restoration of maternal survival, function, and resilience following catastrophic obstetric bleeding.

Recovery Domains

Hemostatic Recovery

Organ Recovery

Functional Recovery

Output

RHENOVA Maternal Hemorrhage Recovery Score (RMHRS)

RHENOVA Integration

R1 — Survival Preservation

Prevent:

• Maternal exsanguination
• Hemorrhagic shock
• Multiorgan failure

Output:

Maternal Rescue Status

R2 — Recovery Optimization

Restore:

• Hemostatic competence
• Circulatory stability
• Organ perfusion

Output:

Recovery Readiness Score

R3 — Regenerative Preservation

Protect:

• Organ reserve
• Reproductive potential when feasible
• Maternal adaptive capacity

Output:

Maternal Preservation Profile

R4 — Functional Restoration

Achieve:

• Maternal rehabilitation
• Maternal–infant reintegration
• Return to meaningful function

Output:

Maternal Restoration Matrix

R5 — Long-Term Resilience

Prevent:

• Delayed hemorrhagic complications
• Chronic organ dysfunction
• Psychosocial deterioration
• Reproductive sequelae
• Persistent disability

Output:

Maternal Resilience Profile

SCF-DBI Postpartum Hemorrhage Surgery Workflow

Step 1

Identify Maternal Hemostatic Resilience Failure.

Output

Maternal Hemorrhage Severity Score.

Step 2

Activate massive obstetric hemorrhage response and perform definitive surgical hemorrhage control.

Output

Maternal Hemostatic Resilience Network Restoration Confirmation.

Step 3

Initiate the Hemostatic–Circulatory Rescue Algorithm.

Output

Hemostatic–Circulatory Rescue Score.

Step 4

Assess coagulation intelligence.

Output

Coagulation Intelligence Score.

Step 5

Evaluate organ perfusion preservation.

Output

Organ Perfusion Score.

Step 6

Assess reproductive preservation and maternal recovery readiness.

Output

Reproductive Preservation Score and Maternal Recovery Readiness Score.

Step 7

Generate the RHENOVA Maternal Hemorrhage Matrix.

Output

RHENOVA Maternal Hemorrhage Recovery Score.

Glossary

SCF Principle Alignment

INDEX

SCF-OB-POSTPARTUM-HEMORRHAGE-SURGERY-0001

SCF-DBI-MATERNAL-HEMOSTATIC-RESILIENCE-NETWORK-0001

SCF-DBI-MATERNAL-HEMOSTATIC-RESILIENCE-FAILURE-SYNDROME-0001

SCF-DBI-HEMOSTATIC-CIRCULATORY-RESCUE-ALGORITHM-0001

SCF-DBI-HEMOSTATIC-CIRCULATORY-RESCUE-SCORE-0001

SCF-DBI-COAGULATION-INTELLIGENCE-SCORE-0001

SCF-DBI-ORGAN-PERFUSION-SCORE-0001

SCF-DBI-REPRODUCTIVE-PRESERVATION-SCORE-PPH-0001

SCF-DBI-MATERNAL-RECOVERY-READINESS-SCORE-0001

SCF-DBI-RHENOVA-MATERNAL-HEMORRHAGE-MATRIX-0001

SCF-POSTPARTUM-HEMORRHAGE-SURGERY-WORKFLOW-0085

SCF-POSTPARTUM-HEMORRHAGE-SURGERY-MASTER-0001