Recombinant Factor VII for the Conservative Management Trials of Intractable Postpartum Haemorrhage: Is it a Drug Effect, Operator Experience or Inherent Result of the Aetiology

Abstract

Aim: This monocentric retrospective study aimed at the evaluation of outcome of the parturients with intractable postpartum haemorrhage (P.P.H.) after the administration of recombinant activated factor VII (rFVIIa) to preserve the uterus. Materials and Methods: this is a retrospective study conducted in a tertiary hospital . 41 patients were selected based on the inclusion criteria of both suffering from postpartum hemorrhage and received recombinant activated factor VII (rFVIIa). Patients were divided into group A who were managed by senior staff and group B who had started their management by junior staff and senior staff was called later for the case. Data was retrieved from patients' records during 2019. All patients had a preliminary evaluation and classic management measures for postpartum hemorrhage either in the emergency department or during planned cesarean section. If are still bleeding, patients were infused with rFVIIa. If the uterine bleeding didn't stop, conservative management was cancelled, and abdominal hysterectomy was done. In all cases, postpartum mortality was determined. Results:The study included 41 parturient with P.P.H. with a mean age of 30.8±5.4 years. Eighteen patients had a cesarean section (C.S.), of whom 8 had successfully conserved the uterus, and 10 patients had a lifesaving hysterectomy using rFVIIa. On the other hand, 23 patients had been complicated with intractable postpartum haemorrhage. Twenty patients successfully had conservative management after using rFVIIa, and 3 patients had failed conservative management after using rFVIIa, and hysterectomy was lifesaving. Regarding 7-day postpartum mortality, one patient died with an intractable haemorrhage with delayed hysterectomy. Conclusion:The operator seniority and experience is more important than the use of rFVIIa to achieve conservative management of cases suffering from or at great risk of postpartum hemorrhage and to reduce patients mortality.