Authors’ reply re: Intrauterine balloon tamponade for management of severe postpartum haemorrhage in a perinatal network: a prospective cohort study

Rozenberg, Patrick; Revert, Mathilde

doi:10.1111/1471-0528.14499

Cited by 1 publication

(1 citation statement)

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“…First, we need to be able to recognize situations in which hysterectomy will be needed anyway. If surgical and radiological interventions fail most of the time in women with already high volumes of blood loss, with high bleeding rates or who are hemodynamically unstable when these interventions are employed, perhaps treating physicians should immediately perform a hysterectomy .…”

Section: Improving Maternal Outcomes: Obstetric Interventions To Stopmentioning

confidence: 99%

Management of postpartum hemorrhage: how to improve maternal outcomes?

Henriquez

Bloemenkamp

Bom

2018

Journal of Thrombosis and Haemostasis

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Postpartum hemorrhage is the leading cause of maternal mortality and severe morbidity. Despite efforts to improve maternal outcomes, management of postpartum hemorrhage still faces at least four challenges, discussed in this review. First, current definitions for severe postpartum hemorrhage hamper early identification of women with a high risk of adverse outcomes. Adaptations to the definitions and the use of clinical tools such as shock index and early warning systems may facilitate this early identification. Second, surgical and radiological interventions to prevent hysterectomy are not always successful. More knowledge on the influence of patient and bleeding characteristics on the success rates of these interventions is necessary. Scarce data suggest that early timing of intrauterine balloon tamponade may improve maternal outcomes, whereas early timing of arterial embolization seems to be unrelated to maternal outcomes. Third, fluid resuscitation with crystalloids and colloids is unavoidable in the early phases of postpartum hemorrhage but may result in dilutional coagulopathy. Effects of different volumes of clear fluids on the occurrence of dilutional coagulopathy and maternal outcomes is unknown. Fourth, a better understanding of diagnosis and correction of coagulopathy during postpartum hemorrhage is needed. Low plasma fibrinogen levels at the start of postpartum hemorrhage predict progression to severe hemorrhage, but standard coagulation screens are time consuming. A solution may be point-of-care coagulation testing; however, clinical usefulness during postpartum hemorrhage has not been demonstrated. To date, early administration of tranexamic acid is the only hemostatic intervention that was proven to improve outcomes in women with postpartum hemorrhage.

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Section: Improving Maternal Outcomes: Obstetric Interventions To Stopmentioning

confidence: 99%