Medical Advances in the Treatment of Postpartum Hemorrhage

  title={Medical Advances in the Treatment of Postpartum Hemorrhage},
  author={A.-S. Ducloy-Bouthors and Sophie Susen and Cynthia A. Wong and Alexander J. Butwick and Beno{\^i}t Vallet and Evelyn L Lockhart},
  journal={Anesthesia \& Analgesia},
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Recent advances in the management of severe bleeding for trauma patients may provide insight into PPH management, but must be applied with caution considering the significant differences between trauma and obstetric patients. In this review, we summarized evidence for current management strategies for patients with major obstetric hemorrhage, including (1) rapid laboratory assessment of coagulopathy, (2) early… 

Postpartum hemorrhage: a continuing challenge.

  • E. Lockhart
  • Medicine
    Hematology. American Society of Hematology. Education Program
  • 2015
The epidemiology of PPH as well as current recommendations for key elements in obstetric hemorrhage protocols are examined, including recognition of hypofibrinogenemia as a risk factor for severe PPH, use of antifibrinolytic therapy, and strategies for fibrinogens replacement therapy.

Massive obstetric hemorrhage: Current approach to management (cid:2)

Using massive obstetric hemorrhage protocols is useful for facilitating rapid transfusion if needed, and can also be cost-effective and Optimization, preparation, rational use of resources and protocolization of actions are often useful to improve outcomes in patients with postpartum hemorrhage.

Major obstetric hemorrhage.

  • A. Le GouezF. Mercier
  • Medicine
    Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine
  • 2016

Other new players in medical management of postpartum hemorrhage?

The article elegantly presented strategies for early laboratory diagnosis and addressed transfusion protocols and pharmacologic interventions to improve maternal outcomes, it was surprised that the pharmacological segment failed to mention: (a) the impact of newer uterotonic carbetocin and (b) the role of recombinant factor VIIa (rFVIIa) in obstetric hemorrhage.

Successful Hysterectomy and Therapeutic Hypothermia Following Cardiac Arrest due to Postpartum Hemorrhage

A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation, and experienced massive postpartum bleeding, which led to cardiac arrest, and was placed under therapeutic hypothermia management.

Collaborative Strategies for Management of Obstetric Hemorrhage.

The diagnosis and management of morbidly adherent placenta.

It is important for clinicians to screen all pregnancies for MAP at the time of routine second-trimester ultrasonography and patients with risk factors (e.g., multiple prior cesarean deliveries) should undergo targeted screening for MAP.

Anesthetic and Obstetric Management of Placenta Accreta: Clinical Experience and Available Evidence

This article reviews anesthetic and obstetric management of patients with placenta accreta based on clinician experience and the current literature, with emphasis on several controversial aspects of care, including timing of delivery, whether and when conservative Obstetric management should be considered, the role of perioperative interventional radiology, and the risks and benefits of general versus neuraxial anesthesia.

Coagulation abnormalities and bleeding in pregnancy: an anesthesiologist’s perspective

  • H. Yoon
  • Medicine
    Anesthesia and pain medicine
  • 2019
Platelet count and function and the effect of anticoagulant treatment should be assessed to determine the risk of hematoma associated with regional anesthesia, and anesthesiologists should monitor patients for postpartum hemorrhage (PPH), and attention should be paid when performing rapid coagulation tests, transfusions, and prohemostatic pharmacotherapy.



Postpartum hemorrhage: When uterotonics and sutures fail

Coagulation laboratory evaluation may be useful in guiding hemostatic management during massive PPH, but for the results to be useful, they must be rapidly available and provide information that would not be available from clinical assessment alone.

Algorithm-based coagulation management of catastrophic amniotic fluid embolism

Stable clotting situation was maintained despite further clinical deterioration and development of multiple organ failure in this patient, and an algorithm-based approach in managing coagulopathy and hemorrhage in a fatal case of histopathologically proven AFE is presented.

An Observational Study of the Fresh Frozen Plasma: Red Blood Cell Ratio in Postpartum Hemorrhage

A higher FFP:RBC ratio was associated with a lower requirement for advanced interventional procedures in the setting of postpartum hemorrhage, and the benefits of transfusion using a higher F FP:R BC ratio should be confirmed by randomized-controlled trials.

The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage

Findings indicate that a simple fibrinogen measurement can anticipate the risk of severe bleeding in PPH.

Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study

Five independent predictors of the need for an AIP in patients with SPPH and persistent bleeding are identified and using these predictors in a single score could be a reliable screening tool in patients at risk of persistent genital tract bleeding and needing an Aip.

The FIB-PPH trial: fibrinogen concentrate as initial treatment for postpartum haemorrhage: study protocol for a randomised controlled trial

The FIB-PPH trial aims to provide an evidence-based platform for the recommendations of the early use of fibrinogen concentrate in PPH, and investigates a 33% reduction in the need for blood transfusion in women suffering severe PPH.

The Epidemiology of Postpartum Hemorrhage in a Large, Nationwide Sample of Deliveries

PPH caused by uterine atony resulting in transfusion often occurs in the absence of recognized risk factors and is associated with substantial maternal morbidity and mortality.

Evaluation and management of postpartum hemorrhage: consensus from an international expert panel

Postpartum hemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide, although the lack of a precise definition precludes accurate data of the absolute