A minimally invasive hemostatic strategy in obstetrics aiming to preserve uterine function and enhance the safety of subsequent pregnancies

Hemostasis for Massive Hemorrhage during Cesarean Section

“…In many cases, the amount of bleeding is underestimated, and the timing of transfusion may be delayed. Therefore, maintaining the blood pressure such as infusion of large volumes of artificial colloid solution and albumin solution, and quick implementation of temporizing hemostatic procedures such as packing, manual uterine compression, and aortic compression, are important until the access to blood transfusion [3].…”

“…Administration of FFP is necessary for achieving the elevation and maintenance of blood pressure and colloid osmotic pressure. It should be noted that if the patient experiences shock, RBC transfusion alone cannot increase blood pressure; FFP and RBC should be administered at a ratio of 1:1 in the same manner as in cases of trauma [3,5,10]. In cases of consumption coagulopathy, such as in placenta abruption or amniotic fluid embolism, and coagulopathy following massive hemorrhage, the blood fibrinogen level is often <100 mg/dL.…”

“…An analysis of the patients who survived showed that massive hemorrhage during cesarean section accounted for approximately 70% of all cases [2]. Most cases had placenta previa accreta, bleeding from the surface of the placental separation, or concomitant coagulopathy with hemorrhagic tendency [2,3]. Therefore, the technique of controlling hemorrhage during cesarean section must be mastered.…”

“…Therefore, the technique of controlling hemorrhage during cesarean section must be mastered. On the other hand, the widespread use of TAE has made it possible to save the patient's life in most cases of massive hemorrhage after vaginal delivery, unless uterine rupture or some other serious conditions occur [3,4].…”

“…The current revised edition of this guideline [5] recommends a new concept of obstetrical transfusion therapy, treatment of coagulopathy, and hemostatic techniques such as compression sutures, intrauterine balloon tamponade, administration of uterotonics and tranexamic acid [3,[5][6][7][8][9]. If coagulopathy is present, the fibrinogen level becomes extremely low, and reversal of hemorrhagic tendency can be achieved only by administration of cryoprecipitate or fibrinogen concentrate or transfusion of fresh-frozen plasma (FFP) [3,5,10]. In addition, simulation training for obstetrical emergency care has been conducted widely to promote good team medical care in emergency settings [1].…”