Approach to Massive Bleeding in Obstetrics: Changing Management Paradigms Oriented by Early Goals [Early Goal Therapy in Postpartum Hemorrhage]

Abstract

Recent findings: Approximately 830 women die every day worldwide as a result of complications related to pregnancy or childbirth with obstetric hemorrhage that remains a major cause of maternal morbidity and mortality. A systematic analysis by the World Health Organization [WHO] on the global causes of maternal deaths from 2003 to 2009 found that bleeding was the leading direct cause of maternal mortality followed by hypertensive disorders and sepsis. Overall, bleeding accounted for 27.1% of all maternal deaths worldwide. The need to implement strategies that mitigate the impact of bleeding in this clinical scenario is increasingly growing. Purpose of review: The purpose of this review is to propose a management strategy based on goals established through dynamic coagulation assessment. Summary: Effective management of obstetric hemorrhage requires rapid recognition, rapid response and mobilization of the multidisciplinary team. Volumetric resuscitation, hemodynamic stability, as well as the simultaneous identification and treatment of the source of bleeding and the resolution of coagulopathy in the shortest possible time remain the cornerstones of the management of Postpartum Hemorrhage (PPH).