Maternal haemorrhage

Abstract

Maternal haemorrhage is the leading cause of preventable maternal death worldwide and encompasses antepartum, intrapartum, and postpartum bleeding. This review highlights factors that predispose to severe bleeding, its management, and the most recent treatment and guidelines. Advances in obstetric care have provided physicians with the diagnostic tools to detect, anticipate, and prevent severe life-threatening maternal haemorrhage in most patients who have had prenatal care. In an optimal setting, patients at high risk for haemorrhage are referred to tertiary care centres where multidisciplinary teams are prepared to care for and deal with known potential complications. However, even with the best prenatal care, unexpected haemorrhage occurs. The first step in management is stabilization of haemodynamic status, which involves securing large bore i.v. access, invasive monitoring, and aggressive fluid management and transfusion therapy. Care for the patient with maternal bleeding should follow an algorithm that goes through a rapid and successive sequence of medical and surgical approaches to stem bleeding and decrease morbidity and mortality. With the addition of potent uterotonic agents and the advent of minimally invasive interventional radiological techniques such as angiographic embolization and arterial ligation, definitive yet conservative management is now possible in an attempt to avoid hysterectomy in patients with severe peripartum bleeding. If these interventions are inadequate to control the bleeding, the decision to proceed to hysterectomy must be made expeditiously. Recombinant factor VIIa is a relatively new treatment that could prove useful for severe coagulopathy and intractable bleeding.

Histerectomía Posparto: Experiencia De Clínica Las Condes

“…En nuestra casuística la principal causa que originó la histerectomía fue el acretismo placentario, seguido de la inercia uterina, la rotura uterina y mioma uterino coexistente. Otras series, especialmente las de países en desarrollo muestran como primera causa la inercia uterina, llegando en algunas estadísticas hasta el 80%, mientras que otros estudios, muestran los defectos de placentación asociados a cesá-reas previas como la primera causa (4,9,11,(15)(16)(17)(18)(19).…”

Peripartum Management of Placenta Previa and Abruption Placenta in Rural Perspectives: A Real Test of Obstetrician’s Clinical and Surgical Skills

“…Uncontrolled severe bleeding in PPH may leads to lethal cascade of hypothermia, coagulopathy, and metabolic acidosis. Criteria proposed for this in extrems state include pH 7.30, temp 35°C, combined resuscitation and procedure time >90min, non mechanical bleeding and transfusion required more than 10 units 9 . Urgent haemostasis is the key to break this vicious cycle and low threshold for hysterectomy is justified to save the life of patient in such cases.…”

Transfusjonsmedisin ved et hundreårsmerke

“…The WHO estimates, for example, that approximately 800 women die in childbirth every day (31), and that bleeding is the cause of death in 25 -30 % of cases (32). In 2014, many countries have an inadequate transfusion service.…”