Obstetric hemorrhage

Marc Van De Velde, Christian Diez, Albert J. Varon

Research output: Contribution to journalReview article

13 Scopus citations

Abstract

Purpose of review: To provide a review of the current literature on the management of obstetric hemorrhage. Recent findings: Obstetric hemorrhage remains a prominent cause of maternal morbidity and mortality. When postpartum hemorrhage is refractory to manual and pharmacologic treatments, escalating interventions may be needed. Second-line interventions include the use of intrauterine balloon (or gauze) tamponade and uterine compression sutures. If these therapies fail to stop the bleeding, patients may need to undergo radiological embolization, pelvic devascularization, or hysterectomy. In recent years, pelvic arterial embolization has become a common treatment for intractable postpartum hemorrhage in an effort to avoid hysterectomy. The use of prophylactic arterial catheterization in the management of cases with expected major postpartum hemorrhage (e.g., placenta increta or percreta) has also been reported. However, the efficacy and safety of this technique requires further study. Summary: Postpartum hemorrhage is best managed by using a stepwise progressive approach. Manual and pharmacologic interventions are first-line treatments. Second-line treatments are used when bleeding continues; and hysterectomy is reserved for only the most extreme cases. Outcomes may be improved by thorough preparation, anticipating the risk of obstetric hemorrhage, and coordinating consultants for interventional procedures.

Original languageEnglish (US)
Pages (from-to)186-190
Number of pages5
JournalCurrent opinion in anaesthesiology
Volume28
Issue number2
DOIs
StatePublished - Apr 7 2015

Keywords

  • cell salvage
  • fibrinogen
  • hemorrhage
  • obstetric
  • peripartum hysterectomy
  • postpartum
  • tranexamic acid
  • transfusion
  • uterine atony

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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