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CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(11): 776-784
DOI: 10.1055/s-0040-1721882
DOI: 10.1055/s-0040-1721882
Febrasgo Position Statement
Postpartum hemorrhage: prevention, diagnosis and non-surgical management
Number 5 - November 2020
Key points
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Postpartum hemorrhage is the world's leading cause of maternal death and peripartum hysterectomy.
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The main causes of postpartum hemorrhage are uterine atony, birth canal trauma, retention of placental remains and coagulation disorders.
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Risk stratification for postpartum hemorrhage optimizes care planning and promotes early adoption of preventive measures.
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Bleeding control within the first hour of diagnosis (“golden hour”) is the most effective measure for treating postpartum hemorrhage.
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The shock index is the clinical method of choice for estimating blood loss and a good parameter to guide the need for blood transfusion.
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The main drugs used in pharmacological therapy for postpartum hemorrhage are oxytocin, ergot derivatives, misoprostol and tranexamic acid.
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In uterine atony with pharmacological therapy failure, the intrauterine balloon tamponade should precede the surgical approach.
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The non-pneumatic anti-shock garment is useful in postpartum hemorrhage with hemodynamic instability and enables continuity of treatment and patient transfers.
The National Specialty Commission for Obstetric Emergencies of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) endorses to this document. The content production is based on scientific studies on a thematic proposal and the findings presented contribute to clinical practice.
Publication History
Article published online:
30 November 2020
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
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References
- 1 American College of Obstetricians and Gynecologists, Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum hemorrhage. Obstet Gynecol 2017; 130 (04) e168-86 DOI: 10.1097/AOG.0000000000002351.
- 2 Sosa GC, Althabe F, Belizán JM, Buekens P. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstet Gynecol 2009; 113 (06) 1313-9 DOI: 10.1097/AOG.0b013e3181a66b05.
- 3 Osanan CG, Padilla H, Reis IM, Tavares AB. Strategy for zero maternal deaths by hemorrhage in Brazil: a multidisciplinary initiative to combat maternal morbimortality. Rev Bras Ginecol Obstet 2018; 40 (03) 103-5 DOI: 10.1055/s-0038-1639587.
- 4 Sentilhes L, Gromez A, Clavier E, Resch B, Descamps P, Marpeau L. Long-term psychological impact of severe postpartum hemorrhage. Acta Obstet Gynecol Scand 2011; 90 (06) 615-20 DOI: 10.1111/j.1600-0412.2011.01119.x.
- 5 Lalonde A, Daviss AB, Acosta A, Herschderfer K. Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006. Int J Gynaecol Obstet 2006; 94 (03) 243-53 DOI: 10.1016/j.ijgo.2006.04.016.
- 6 Organização Pan-americana da Saúde. Recomendaçõs assistenciais para prevenção, diagnóstico e tratamento da hemorragia obstétrica. Brasília (DF): Opas; 2018
- 7 Main KE, Goffman D, Scavone MB, Low KL, Bingham D, Fontaine LP. et al. National Partnership for Maternal Safety: consensus bundle on obstetric hemorrhage. Anesth Analg 2015; 121 (01) 142-8 DOI: 10.1097/AOG.0000000000000869.
- 8 Wilkes J. Reducing obstetric hemorrhage: recommendations from the National Partnership for Maternal Safety. Am Fam Physician 2015; 92 (07) 643
- 9 Agency for Healthcare Research and Quality. TeamSTEPPS 2.0: Module 11. Implementation Workshop [Internet]. 2016 [cited 2020 Oct 12). Available from: https://www.ahrq.gov/teamstepps/instructor/fundamentals/module11/igimplement.html
- 10 Prevention and management of postpartum haemorrhage: Green-top Guideline No. 52. BJOG. 2016; 124 (05) e106-49 DOI: 10.1111/1471-0528.14178.
- 11 Liu Y, Shen Y, Zhu W, Qiu BJ, Huang Q, Ye WQ. Clinical assessment indicators of postpartum hemorrhage: a systematic review. Chin Nurs Res 2017; 4 (04) 170-7 DOI: 10.1016/j.cnre.2017.10.003.
- 12 Lilley G, Burkett-St-Laurent D, Precious E, Bruynseels D, Kaye A, Sanders J. et al. Measurement of blood loss during postpartum haemorrhage. Int J Obstet Anesth 2015; 24 (01) 8-14 DOI: 10.1016/j.ijoa.2014.07.009.
- 13 Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG 2006; 113 (08) 919-24 DOI: 10.1111/j.1471-0528.2006.01018.x.
- 14 Dildy 3rd GA, Paine RA, George CN, Velasco C. Estimating blood loss: can teaching significantly improve visual estimation?. Obstet Gynecol 2004; 104 (03) 601-6 DOI: 10.1097/01.AOG.0000137873.07820.34.
- 15 Al Kadri MH, Al Anazi KB, Tamim HM. Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study. Arch Gynecol Obstet 2011; 283 (06) 1207-13 DOI: 10.1007/s00404-010-1522-1.
- 16 Lertbunnaphong T, Lapthanapat N, Leetheeragul J, Hakularb P, Ownon A. Postpartum blood loss: visual estimation versus objective quantification with a novel birthing drape. Singapore Med J 2016; 57 (06) 325-8 DOI: 10.11622/smedj.2016107.
- 17 Cannon MC, Braxton CC, Kling-Smith M, Mahnken DJ, Carlton E, Moncure M. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma 2009; 67 (06) 1426-30 DOI: 10.1097/TA.0b013e3181bbf728.
- 18 Nathan LH, El Ayadi A, Hezelgrave LN, Seed P, Butrick E, Miller S. et al. Shock index: an effective predictor of outcome in postpartum haemorrhage?. BJOG 2015; 122 (02) 268-75 DOI: 10.1111/1471-0528.13206.
- 19 Chantrapitak W, Anansakalwat W, Suwikrom S, Wattanaluangarun R, Puangsa-art S. Postpartum hemorrhage outcome in lower uterine segment compression maneuver: a 20-year experience in Charoenkrung Pracharak Hospital. J Med Assoc Thai 2018; 101 (04) 495-500
- 20 Anderson MJ, Duncan E. Prevention and management of postpartum hemorrhage. Am Fam Physician 2007; 75 (06) 876-81
- 21 Woman Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389 (10084): 2105-16 DOI: 10.1016/S0140-6736(17)30638-4.
- 22 Alves ALL, Silva BL, Melo VH. Uso de balões intrauterinos em pacientes com hemorragia pós-parto. Femina 2014; 42 (04) 193-201
- 23 Keriakos R, Chaudhuri S. Operativeinterventionsinthemanagement of major postpartum haemorrhage. J Obstet Gynaecol 2012; 32 (01) 14-25 DOI: 10.3109/01443615.2011.615418.
- 24 Georgiou C. Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG 2009; 116 (06) 748-57 DOI: 10.1111/j.1471-0528.2009.02113.x.
- 25 Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, Suarez-Rebling D, Eckardt M, Theron G. et al. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 222 (04) 293.e1-e52 DOI: 10.1016/j.ajog.2019.11.1287.
- 26 Park EJ, Park KJ, Jo CH, Cho AI, Baek JC. The association between intrauterine balloon tamponade volume and postpartum hemorrhage outcomes. Int J Gynecol Obstet 2020; 148 (03) 325-30 DOI: 10.1002/ijgo.13069.
- 27 Wong SM, Dellapiana G, Greene N, Gregory KD. Antibiotics during intrauterine balloon tamponade is associated with a reduction in endometritis. Am J Perinatol 2019; 36 (12) 1211-5 DOI: 10.1055/s-0039-1683888.
- 28 Condous CG, Arulkumaran S, Symonds I, Chapman R, Sinha A, Razvi K. The “Tamponade Test” in the management of massive postpartum hemorrhage. Obstet Gynecol 2003; 101 (04) 767-72 DOI: 10.1016/s0029-7844(03)00046-2.
- 29 Bakri NY, Ramin MS, Barss VA. Use of intrauterine balloon catheters for control of uterine hemorrhage [Internet]. 2011 [cited 2019 Dec 12]. . Available from: https://somepomed.org/articulos/contents/mobipreview.htm?10/23/10623
- 30 Einerson DB, Son M, Schneider P, Fields I, Miller ES. The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes. Am J Obstet Gynecol 2017; 216 (03) 300.e1-e5 DOI: 10.1016/j.ajog.2016.10.040.
- 31 Miller S, Martin BH, Morris JL. Anti-shock garment in postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol 2008; 22 (06) 1057-74 DOI: 10.1016/j.bpobgyn.2008.08.008.
- 32 Figo Safe Motherhood Committee, International Federation of Gynecology and Obstetrics. Non-pneumatic anti-shock garment to stabilize women with hypovolemic shock secondary to obstetric hemorrhage. Int J Gynaecol Obstet 2015; 128 (03) 194-5 DOI: 10.1016/j.ijgo.2014.10.014.
- 33 Kramer SM, Berg C, Abenhaim H, Dahhou M, Rouleau J, Mehrabadi A. et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol 2013; 209 (05) 449.e1-e7 DOI: 10.1016/j.ajog.2013.07.007.
- 34 Federación Latinoamericana de Asociaciones de Sociedades de Obstetricia y Ginecología, Hemorragia postparto. Donde estamos y hacia donde vamos?. Paitilla: FLASOG; 2018
- 35 Zaidi A, Kohli R, Daru J, Estcourt L, Khan SK, Thangaratinam S. et al. Early use of fibrinogen replacement therapy in postpartum hemorrhage. A systematic review. Transfus Med Rev 2020; 34 (02) 101-7 DOI: 10.1016/j.tmrv.2019.12.002.