Postpartum hemorrhage management, the importance of timing.

Claudia Claroni, Marco Aversano, Cristina Todde, Maria Grazia Frigo

DOI: https://doi.org/10.7175/cmi.v12i1.1326

Abstract

Postpartum hemorrhage is defined as a blood loss equal to or greater than 500 ml, which can occur from 24 hours to six weeks after delivery. It is a critical event with a rapid and devastating evolution, which can quickly lead to maternal shock and death.

Many efforts have been made to create international and multisectoral guidelines that allow to face an event that represents the cause of about one quarter of maternal deaths. It is crucial to create a team able to act promptly in accordance with shared protocols. The availability of shared guidelines and protocols and the organization of periodic simulations and teamwork training are part of the fundamental initiatives that can promote the safety of perinatal care.

The purpose of this document is to give clinicians the tools to minimize the risks associated with inadequate management of hemorrhagic emergency, avoiding the risk of “too little or too late” and giving patients maximum safety.

 

Keywords

Postpartum Hemorrhage; Obstetric Labor Complications; Pregnancy Complications; Shock, Hemorrhagic; Blood Coagulation Disorders; Uterine Inertia

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References

  • SIGO, AOGOI, AGUI, et al. Gestione multidisciplinare emorragia post partum. Algoritmo. 2014. Available at: www.sigo.it/wp-content/uploads/2015/10/algoritmo-epp1.pdf (last accessed January 2018)
  • Affronti G, Agostini V, Brizzi A, et al. The daily-practiced post-partum hemorrhage management: an Italian multidisciplinary attended protocol. Clin Ter 2017; 168: e307-e316; https://doi.org/10.7417/T.2017.2026
  • World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO, 2012
  • Cantwell R, Clutton-Brock T, Cooper G. et al. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG 2011; 118 Suppl 1: 1-203; https://doi.org/10.1111/j.1471-0528.2010.02847.x
  • Bateman BT, Berman MF, Riley L, et al. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 2010; 110: 1368-73; http://dx.doi.org/10.1213/ANE.0b013e3181d74898; https://doi.org/10.1213/ANE.0b013e3181d74898
  • Mousa HA, Blum J, Abou El Senoun G, et al. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2014; (2): CD003249; https://doi.org/10.1002/14651858.CD003249.pub3
  • Alexander J, Thomas PW, Sanghera J. Treatments for secondary postpartum haemorrhage. Cochrane Database Syst Rev 2002; (1): CD002867; https://doi.org/10.1002/14651858.CD002867
  • Mavrides E, Allard S, Chandraharan E, et al; on behalf of the Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage. BJOG 2016; 124: e106–e149
  • Donati S, Basevi V (Editors). Linee Guida Nazionali: Emorragia post partum: come prevenirla, come curarla. Available at http://www.iss.it/binary/moma/cont/LGEPPcorrige.pdf (last accessed January 2018)
  • Lancé MD. The management of critical bleeding in obstetrics. Reviews in Health Care 2013; 4(Suppl 3): 41-51. http://dx.doi.org/10.7175/rhc.v4i3s.879; https://doi.org/10.7175/rhc.v4i3S.879
  • Mukherjee S, Sabaratnam A. Post-partum haemorrhage. Obstet Gynaecol Reprod Med 2009; 19: 121-6. http://dx.doi.org/10.1016/j.ogrm.2009.01.005; https://doi.org/10.1016/j.ogrm.2009.01.005
  • WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389: 2105-16; https://doi.org/10.1016/S0140-6736(17)30638-4
  • Lalonde A, International Federation of Gynecology and Obstetrics. Prevention and treatment of postpartum hemorrhage in low-resource settings. Int J Gynaecol Obstet 2012; 117: 108-18; https://doi.org/10.1016/j.ijgo.2012.03.001
  • Mousa HA, Alfirevic Z. Major postpartum hemorrhage: survey of maternity units in the United Kingdom. Acta Obstet Gynecol Scand 2002; 81: 727-30; https://doi.org/10.1034/j.1600-0412.2002.810807.x
  • Engelsen IB, Albrechtsen S, Iversen OE. Peripartum hysterectomy-incidence and maternal morbidity. Acta Obstet Gynecol Scand 2001; 80: 409-12; https://doi.org/10.1034/j.1600-0412.2001.080005409.x

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