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

  • Abdul-Kadir R
  • McLintock C
  • Ducloy A
 et al. 
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Abstract

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 prevalence of PPH. Study Design and Methods An international expert panel in obstetrics, gynecology, hematology, transfusion, and anesthesiology undertook a comprehensive review of the literature. At a meeting in November 2011, the panel agreed on a definition of severe PPH that would identify those women who were at a high risk of adverse clinical outcomes. Results The panel agreed on the following definition for severe persistent (ongoing) PPH: "Active bleeding >1000mL within the 24 hours following birth that continues despite the use of initial measures including first-line uterotonic agents and uterine massage." A treatment algorithm for severe persistent PPH was subsequently developed. Initial evaluations include measurement of blood loss and clinical assessments of PPH severity. Coagulation screens should be performed as soon as persistent (ongoing) PPH is diagnosed, to guide subsequent therapy. If initial measures fail to stop bleeding and uterine atony persists, second- and third-line (if required) interventions should be instated. These include mechanical or surgical maneuvers, i.e., intrauterine balloon tamponade or hemostatic brace sutures with hysterectomy as the final surgical option for uncontrollable PPH. Pharmacologic options include hemostatic agents (tranexamic acid), with timely transfusion of blood and plasma products playing an important role in persistent and severe PPH. Conclusion Early, aggressive, and coordinated intervention by health care professionals is critical in minimizing blood loss to ensure optimal clinical outcomes in management of women with severe, persistent PPH. © 2014 AABB.

Author-supplied keywords

  • Bernard Soulier disease
  • Glanzmann disease
  • algorithm
  • alloimmunization
  • antifibrinolytic agent
  • article
  • blood clotting disorder
  • blood clotting factor concentrate
  • blood transfusion
  • breast feeding
  • clinical assessment
  • consensus
  • cryoprecipitate
  • crystalloid
  • desmopressin
  • disease carrier
  • disease severity
  • ergometrine plus oxytocin
  • erythrocyte transfusion
  • evaluation study
  • fibrinogen
  • fibrinogen blood level
  • fibrinogen concentrate
  • genital injury
  • hemophilia A
  • hemophilia B
  • hemorrhagic shock
  • hemostatic agent
  • heparin
  • human
  • hypofibrinogenemia
  • hysterectomy
  • intermittent pneumatic compression device
  • intrauterine balloon
  • labor management
  • labor stage 3
  • low molecular weight heparin
  • maternal morbidity
  • maternal mortality
  • meta analysis
  • multicenter study (topic)
  • off label drug use
  • outcome assessment
  • oxytocin
  • partial thromboplastin time
  • plate count
  • point of care testing
  • postpartum hemorrhage
  • practice guideline
  • prothrombin time
  • randomized controlled trial (topic)
  • recombinant blood clotting factor 7a
  • retained placenta
  • risk assessment
  • spontaneous placental delivery
  • systematic review
  • systematic review (topic)
  • thrombocyte dysfunction
  • thrombocyte transfusion
  • thrombosis prevention
  • tranexamic acid
  • uterine atony
  • uterotonic agent
  • venous thromboembolism
  • von Willebrand disease

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Authors

  • R Abdul-Kadir

  • C McLintock

  • A.-S. Ducloy

  • H El-Refaey

  • A England

  • A B Federici

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