A Survey of Current Treatment Practices for Postpartum Hemorrhage by Practicing Obstetricians and Hematologists

Abstract

Objective: To identify current treatment strategies for postpartum hemorrhage used by obstetricians (OB/GYNs) and hematologists (HEMs). Study Design: We conducted a survey of OB/GYNs (n = 220) and HEMs (n = 30) to describe the characteristics of current treatment strategies for postpartum hemorrhage. Surveys were administered via a structured questionnaire on a secure internet website from 5 -12 October 2009. Results: The majority of OB/GYN and HEM respondents were practicing in a community hospital environment (77%). Of the OB/GYNs, the majority practiced at hospitals with over 2000 deliveries per year (77%). A majority (58%) of OB/GYNs were affiliated with hospitals that lacked a massive transfusion protocol to treat severe postpartum hemorrhage. Subsequent to uterine massage and additional oxytocin, the majority of OB/GYNs (73%), preferred the administration of Methergine ® as the next level of intervention for postpartum hemorrhage. There was considerable variability in response to specific treatment strategies for several hypothetical case scenarios; however, the large majority of OB/GYNs favored obstetrical procedures over interventional radiology or administration of rFVIIa. A large majority (77%) of physicians who are familiar with rRVIIa as treatment for postpartum hemorrhage reported being very satisfied with the agent for this indication. Conclusions: An established, systematic treatment strategy among OB/GYNs emerged only in the case of mild postpartum hemorrhage.

Hemostatic assessment, treatment strategies, and hematology consultation in massive postpartum hemorrhage: results of a quantitative survey of obstetrician-gynecologists

“…With the exception of limited summary data from administrative databases, clinical guidelines, and the results of another recently published survey, 20 there are few data about how obstetrician-gynecologists manage massive PPH, especially with regard to hemostatic assessment and engagement of hematologic specialists. In the other recently published PPH management survey, fewer than half of patients with PPH managed by obstetrician-gynecologists ever had a hematologic evaluation.…”

“…In the other recently published PPH management survey, fewer than half of patients with PPH managed by obstetrician-gynecologists ever had a hematologic evaluation. 20 The purpose of this study was to assess potential diagnostic and practice barriers to successful management of massive PPH resulting from the most common to the rarest causes, including experience with PPH associated with bleeding disorders.…”