Modern approaches to diagnosis, treatment and prevention of postpartum hemorrhage (literature review)

Abstract

Postpartum hemorrhage (PPH) remains one of the main causes of maternal morbidity and mortality worldwide, despite the progress of medical science and the introduction of new methods of diagnosis and therapy of hemorrhagic complications during pregnancy, childbirth and the postpartum period. Aim — to familiarize the general public with the latest recommendations of the International Federation of Gynecology and Obstetrics (FIGO, 2022) and our own experience regarding the most effective and evidence-based methods of diagnosis, therapy and prevention of PPH. Postpartum hemorrhage is classified into primary (early), which occurs when more than 500 ml of blood is lost during the first 24 hours after childbirth, and secondary (late), which occurs after 24 hours and up to 6 weeks after childbirth. The initial examination of the patient should include a rapid clinical assessment and analysis of risk factors. In order to objectify the volume of blood loss according to FIGO recommendations, the shock index (SI) should be used. Treatment should be directed at the specific cause of PPH (uterine atony, genital trauma, retained placenta and/or coagulopathy), and therapeutic steps should move from a less invasive method to a more complex and radical approach. In the case of refractory PPH, it is necessary to use the most effective modern methods of surgical hemostasis: ligation of the main uterine vessels, compression sutures on the uterus, bilateral ligation of the internal iliac arteries, methods of remodeling the lower uterine segment (LUS-1,2). The paradigm of infusion-transfusion therapy for massive PPH has changed, which is based on the concept of damage control resuscitation (DCR), which is based on warming the parturient, limited use of crystalloids, permissive hypotension tactics, early initiation of blood product transfusion, use of massive blood transfusion protocols, and targeted correction of coagulopathy. PPH prevention strategies include prenatal identification of risk factors, correction of anemia during pregnancy, active management of the third stage of labor, and intravenous administration of tranexamic acid. Conclusions. The implementation of the latest FIGO recommendations for the prevention, diagnosis, and treatment of PPH in the practice of obstetric facilities in the country will contribute to reducing maternal morbidity and mortality.