Clinical obstetrics and gynecology
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Obstetric hemorrhage remains the most important cause of maternal mortality worldwide, accounting for 30% of all direct maternal deaths. As the method of management depends on multiple concurrent and sequential evaluations of the patient's status, it is helpful to have an evaluation strategy prepared for when a postpartum hemorrhage is encountered to facilitate interventions. This review describes an etiology-based approach to the clinical evaluation of postpartum hemorrhage and a suggested systems process that allows both a timely and appropriate evaluation of the hemorrhaging mother.
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Placenta accreta is the abnormal adherence of the placenta to the uterine wall. Where placenta accreta is present, the failure of the placenta to separate normally from the uterus after delivery is accompanied by severe postpartum hemorrhage. ⋯ Management should take place in centers with special expertise. All obstetric units should have an obstetric hemorrhage protocol in place.
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Clin Obstet Gynecol · Mar 2010
ReviewPostpartum hemorrhage: evidence-based medical interventions for prevention and treatment.
Postpartum hemorrhage (PPH) remains a significant contributor to maternal morbidity and mortality throughout the world. The majority of research on this topic has focused on efforts to prevent PPH. ⋯ Misoprostol may be a reasonable option where parenteral administration of an uterotonic is not feasible. There is little evidence to guide treatment decisions should PPH occur.
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Hemorrhage requiring blood transfusion is a common occurrence in obstetrics. This article reviews each step in the transfusion process, including laboratory preparation of blood, indications for various blood components, complications of blood transfusion, massive transfusion, and alternatives to homologous blood. Current thinking regarding transfusion-related acute lung injury, transfusion-related immunomodulation, early use of plasma for massive transfusion, and the use of adjuvant agents such as activated recombinant factor VII are also discussed.
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Clin Obstet Gynecol · Mar 2010
ReviewThe use of recombinant activated FVII in postpartum hemorrhage.
Severe bleeding remains a leading cause of morbidity and mortality in obstetrics. The first-line standard treatment of massive postpartum hemorrhage (PPH) includes medical measures directed at improving uterine tone, replacement of lost intravascular volume, blood and coagulation factors, and surgical or invasive procedures. Recently, a number of case reports or case series have reported the successful "off-label" use of recombinant activated factor VII (rFVIIa) in PPH unresponsive to conventional treatments. ⋯ No randomized controlled trials have been conducted in this area. Currently, the literature data suggest that, at a median dose of 81.5 microg/kg, rFVIIa is effective in stopping or reducing bleeding in 85% of the cases. Finally, on the basis of the evidence from the literature and on own experience, we included some recommendations and an algorithm on the therapeutic role of rFVIIa in the management of PPH.