Managing obstetric haemorrhage: is it time for a more personalised approach?

Shah, Akshay; Collis, Rachel

doi:10.1111/anae.14661

Cited by 4 publications

(1 citation statement)

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“…For example, in obstetrics, the most common causes of haemorrhage are uterine atony and genital tract trauma. These are not associated with significant coagulopathy, and fibrinogen levels are relatively well maintained even with large blood losses [ 41 ]. One observational study found no difference in 30‐day survival in patients without traumatic injury who required a massive transfusion and received a high RBC:FFP ratio compared with those who received a low ratio [ 42 ].…”

Section: What Is the Optimal Rbc : Ffp ...mentioning

confidence: 99%

Major haemorrhage: past, present and future

et al. 2022

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Summary Major haemorrhage is a leading cause of morbidity and mortality worldwide. Successful treatment requires early recognition, planned responses, readily available resources (such as blood products) and rapid access to surgery or interventional radiology. Major haemorrhage is often accompanied by volume loss, haemodilution, acidaemia, hypothermia and coagulopathy (factor consumption and fibrinolysis). Management of major haemorrhage over the past decade has evolved to now deliver a ‘package’ of haemostatic resuscitation including: surgical or radiological control of bleeding; regular monitoring of haemostasis; advanced critical care support; and avoidance of the lethal triad of hypothermia, acidaemia and coagulopathy. Recent trial data advocate for a more personalised approach depending on the clinical scenario. Fresh frozen plasma should be given as early as possible in major trauma in a 1:1 ratio with red blood cells until the results of coagulation tests are available. Tranexamic acid is a cheap, life‐saving drug and is advocated in major trauma, postpartum haemorrhage and surgery, but not in patients with gastrointestinal bleeding. Fibrinogen levels should be maintained > 2 g.l−1 in postpartum haemorrhage and > 1.5 g.l−1 in other haemorrhage. Improving outcomes after major traumatic haemorrhage is now driving research to include extending blood‐product resuscitation into prehospital care.

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Section: What Is the Optimal Rbc : Ffp ...mentioning

confidence: 99%