Download PDF
Semin Thromb Hemost 2012; 38(03): 259-264
DOI: 10.1055/s-0032-1302441
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prohemostatic Interventions in Obstetric Hemorrhage

Marie-Pierre Bonnet
1   Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
2   INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Hôpital Saint-Vincent de Paul, Paris, France. UPMC Université Paris 6, Paris, France
3   Anesthesia and Critical Care Department, Hôpital Cochin, Groupement Hospitalier Universitaire Université Paris 05 René Descartes, Paris, France
,
Olga Basso
1   Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
4   Department of Obstetrics and Gynecology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
18 February 2012 (online)

    Permissions and Reprints

Abstract

Obstetric hemorrhage is a major cause of maternal morbidity and mortality. Pregnancy is associated with substantial hemostatic changes, resulting in a relatively hypercoagulable state. Acquired coagulopathy can, however, develop rapidly in severe obstetric hemorrhage. Therefore, prohemostatic treatments based on high fresh frozen plasma and red blood cell (FFP:RBC) ratio transfusion and procoagulant agents (fibrinogen concentrates, recombinant activated factor VII, and tranexamic acid) are crucial aspects of management. Often, evidence from trauma patients is applied to obstetric hemorrhage management, although distinct differences exist between the two situations. Therefore, until efficacy and safety are demonstrated in obstetric hemorrhage, clinicians should be cautious about wholesale adoption of high FFP:RBC ratio products. Applications of transfusion protocols, dedicated to massive obstetric hemorrhage and multidisciplinarily developed, currently remain the best available option. Similarly, while procoagulant agents appear promising in treatment of obstetric hemorrhage, caution is nonetheless warranted as long as clear evidence in the context of obstetric hemorrhage is lacking.

Keywords

obstetric hemorrhage - blood products - fibrinogen - tranexamic acid - recombinant activated factor VII
 

  • References

  • 1 Hogan MC, Foreman KJ, Naghavi M , et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010; 375 (9726) 1609-1623
    CrossrefPubMedGoogle Scholar
  • 2 Knight M, Callaghan WM, Berg C , et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth 2009; 9: 55
    CrossrefPubMedGoogle Scholar
  • 3 Stafford I, Dildy GA, Clark SL, Belfort MA. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol 2008; 5: 519 e1-7
    PubMedGoogle Scholar
  • 4 Mousa HA, Walkinshaw S. Major postpartum haemorrhage. Curr Opin Obstet Gynecol 2001; 13 (6) 595-603
    CrossrefPubMedGoogle Scholar
  • 5 Joseph KS, Rouleau J, Kramer MS, Young DC, Liston RM, Baskett TF ; Maternal Health Study Group of the Canadian Perinatal Surveillance System. Investigation of an increase in postpartum haemorrhage in Canada. BJOG 2007; 114 (6) 751-759
    CrossrefPubMedGoogle Scholar
  • 6 Ford JB, Roberts CL, Simpson JM, Vaughan J, Cameron CA. Increased postpartum hemorrhage rates in Australia. Int J Gynaecol Obstet 2007; 98 (3) 237-243
    CrossrefPubMedGoogle Scholar
  • 7 Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 2010; 110 (5) 1368-1373
    CrossrefPubMedGoogle Scholar
  • 8 McLintock C, James AH. Obstetric hemorrhage. J Thromb Haemost 2011; 9: 1441-1451
    CrossrefPubMedGoogle Scholar
  • 9 Walfish M, Neuman A, Wlody D. Maternal haemorrhage. Br J Anaesth 2009; 103 (Suppl. 01) i47-i56
    CrossrefPubMedGoogle Scholar
  • 10 Hellgren M. Hemostasis during normal pregnancy and puerperium. Semin Thromb Hemost 2003; 29 (2) 125-130
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Younis JS, Shukha M, Ben-Ami M , et al. Evaluation of the protein C global assay during normal pregnancy and after assisted reproduction. Obstet Gynecol 2010; 115 (5) 969-974
    CrossrefPubMedGoogle Scholar
  • 12 O'Riordan MN, Higgins JR. Haemostasis in normal and abnormal pregnancy. Best Pract Res Clin Obstet Gynaecol 2003; 17 (3) 385-396
    CrossrefPubMedGoogle Scholar
  • 13 Higgins JR, Walshe JJ, Darling MR, Norris L, Bonnar J. Hemostasis in the uteroplacental and peripheral circulations in normotensive and pre-eclamptic pregnancies. Am J Obstet Gynecol 1998; 179 (2) 520-526
    CrossrefPubMedGoogle Scholar
  • 14 Conklin K, Backus A. Physiological changes of pregnancy. In: Chestnut DH, ed. Obstetric Anesthesia: Principles and Practice. 2nd ed. St Louis: Mosby; 1999: 17-42
    Google Scholar
  • 15 Taylor Jr FB, Toh CH, Hoots WK, Wada H, Levi M ; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86 (5) 1327-1330
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Thachil J, Toh CH. Disseminated intravascular coagulation in obstetric disorders and its acute haematological management. Blood Rev 2009; 23 (4) 167-176
    CrossrefPubMedGoogle Scholar
  • 17 American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 2006; 105 (1) 198-208
    CrossrefPubMedGoogle Scholar
  • 18 Holcomb JB. Damage control resuscitation. J Trauma 2007; 62 (6) (Suppl) S36-S37
    CrossrefPubMedGoogle Scholar
  • 19 Holcomb JB, Jenkins D, Rhee P , et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 2007; 62 (2) 307-310
    CrossrefPubMedGoogle Scholar
  • 20 Borgman MA, Spinella PC, Perkins JG , et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma 2007; 63 (4) 805-813
    CrossrefPubMedGoogle Scholar
  • 21 Duchesne JC, Hunt JP, Wahl G , et al. Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years?. J Trauma 2008; 65 (2) 272-276, discussion 276–278
    CrossrefPubMedGoogle Scholar
  • 22 Maegele M, Lefering R, Paffrath T, Simanski C, Wutzler S, Bouillon B ; Working Group on Polytrauma of the German Trauma Society (DGU). Changes in transfusion practice in multiple injury between 1993 and 2006: a retrospective analysis on 5389 patients from the German Trauma Registry. Transfus Med 2009; 19 (3) 117-124
    CrossrefPubMedGoogle Scholar
  • 23 Borgman MA, Spinella PC, Holcomb JB , et al. The effect of FFP:RBC ratio on morbidity and mortality in trauma patients based on transfusion prediction score. Vox Sang 2011; 101 (1) 44-54
    CrossrefPubMedGoogle Scholar
  • 24 Ho AM, Dion PW, Cheng CA , et al. A mathematical model for fresh frozen plasma transfusion strategies during major trauma resuscitation with ongoing hemorrhage. Can J Surg 2005; 48 (6) 470-478
    PubMedGoogle Scholar
  • 25 Snyder CW, Weinberg JA, McGwin Jr G , et al. The relationship of blood product ratio to mortality: survival benefit or survival bias?. J Trauma 2009; 66 (2) 358-362, discussion 362–364
    CrossrefPubMedGoogle Scholar
  • 26 Nascimento B, Callum J, Rubenfeld G, Neto JB, Lin Y, Rizoli S. Clinical review: Fresh frozen plasma in massive bleedings - more questions than answers. Crit Care 2010; 14 (1) 202
    CrossrefPubMedGoogle Scholar
  • 27 Inaba K, Branco BC, Rhee P , et al. Impact of plasma transfusion in trauma patients who do not require massive transfusion. J Am Coll Surg 2010; 210 (6) 957-965
    CrossrefPubMedGoogle Scholar
  • 28 Brohi K, Cohen MJ, Davenport RA. Acute coagulopathy of trauma: mechanism, identification and effect. Curr Opin Crit Care 2007; 13 (6) 680-685
    CrossrefPubMedGoogle Scholar
  • 29 Alexander JM, Sarode R, McIntire DD, Burner JD, Leveno KJ. Whole blood in the management of hypovolemia due to obstetric hemorrhage. Obstet Gynecol 2009; 113 (6) 1320-1326
    PubMedGoogle Scholar
  • 30 Johansson PI, Stensballe J. Effect of haemostatic control resuscitation on mortality in massively bleeding patients: a before and after study. Vox Sang 2009; 96 (2) 111-118
    CrossrefPubMedGoogle Scholar
  • 31 Burtelow M, Riley E, Druzin M, Fontaine M, Viele M, Goodnough LT. How we treat: management of life-threatening primary postpartum hemorrhage with a standardized massive transfusion protocol. Transfusion 2007; 47 (9) 1564-1572
    CrossrefPubMedGoogle Scholar
  • 32 Butwick AJ, Hilton G, Riley ET, Carvalho B. Non-invasive measurement of hemoglobin during cesarean hysterectomy: a case series. Int J Obstet Anesth 2011; 20 (3) 240-245
    CrossrefPubMedGoogle Scholar
  • 33 Afshari A, Wikkelsø A, Brok J, Møller AM, Wetterslev J. Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane Database Syst Rev 2011; 3 (3) CD007871
    PubMedGoogle Scholar
  • 34 Rossaint R, Bouillon B, Cerny V , et al; Task Force for Advanced Bleeding Care in Trauma. Management of bleeding following major trauma: an updated European guideline. Crit Care 2010; 14 (2) R52
    CrossrefPubMedGoogle Scholar
  • 35 Roback JD, Caldwell S, Carson J , et al; American Association for the Study of Liver; American Academy of Pediatrics; United States Army; American Society of Anesthesiology; American Society of Hematology. Evidence-based practice guidelines for plasma transfusion. Transfusion 2010; 50 (6) 1227-1239
    CrossrefPubMedGoogle Scholar
  • 36 Charbit B, Mandelbrot L, Samain E , et al; PPH Study Group. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost 2007; 5 (2) 266-273
    CrossrefPubMedGoogle Scholar
  • 37 Chowdhury P, Saayman AG, Paulus U, Findlay GP, Collins PW. Efficacy of standard dose and 30 ml/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients. Br J Haematol 2004; 125 (1) 69-73
    CrossrefPubMedGoogle Scholar
  • 38 Bolton-Maggs PH, Perry DJ, Chalmers EA , et al. The rare coagulation disorders–review with guidelines for management from the United Kingdom Haemophilia Centre Doctors' Organisation. Haemophilia 2004; 5: 593-628
    PubMedGoogle Scholar
  • 39 Haas T, Fries D, Velik-Salchner C, Oswald E, Innerhofer P. Fibrinogen in craniosynostosis surgery. Anesth Analg 2008; 106 (3) 725-731
    CrossrefPubMedGoogle Scholar
  • 40 Fenger-Eriksen C, Lindberg-Larsen M, Christensen AQ, Ingerslev J, Sørensen B. Fibrinogen concentrate substitution therapy in patients with massive haemorrhage and low plasma fibrinogen concentrations. Br J Anaesth 2008; 101 (6) 769-773
    CrossrefPubMedGoogle Scholar
  • 41 Bell SF, Rayment R, Collins PW, Collis RE. The use of fibrinogen concentrate to correct hypofibrinogenaemia rapidly during obstetric haemorrhage. Int J Obstet Anesth 2010; 19 (2) 218-223
    CrossrefPubMedGoogle Scholar
  • 42 Bolliger D, Szlam F, Molinaro RJ, Rahe-Meyer N, Levy JH, Tanaka KA. Finding the optimal concentration range for fibrinogen replacement after severe haemodilution: an in vitro model. Br J Anaesth 2009; 102 (6) 793-799
    CrossrefPubMedGoogle Scholar
  • 43 Franchini M. The use of recombinant activated factor VII in platelet disorders: a critical review of the literature. Blood Transfus 2009; 7 (1) 24-28
    PubMedGoogle Scholar
  • 44 Franchini M, Franchi M, Bergamini V , et al. The use of recombinant activated FVII in postpartum hemorrhage. Clin Obstet Gynecol 2010; 53 (1) 219-227
    CrossrefPubMedGoogle Scholar
  • 45 Yank V, Tuohy CV, Logan AC , et al. Systematic review: benefits and harms of in-hospital use of recombinant factor VIIa for off-label indications. Ann Intern Med 2011; 154 (8) 529-540
    CrossrefPubMedGoogle Scholar
  • 46 Levi M, Levy JH, Andersen HF, Truloff D. Safety of recombinant activated factor VII in randomized clinical trials. N Engl J Med 2010; 363 (19) 1791-1800
    CrossrefPubMedGoogle Scholar
  • 47 Preston JT, Cameron IT, Adams EJ, Smith SK. Comparative study of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia. Br J Obstet Gynaecol 1995; 102 (5) 401-406
    PubMedGoogle Scholar
  • 48 Henry DA, Carless PA, Moxey AJ , et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2007; 4 (4) CD001886
    PubMedGoogle Scholar
  • 49 Shakur H, Roberts I, Bautista R , et al; CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376 (9734) 23-32
    CrossrefPubMedGoogle Scholar
  • 50 Shakur H, Elbourne D, Gülmezoglu M , et al. The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial. Trials 2010; 11: 40
    CrossrefPubMedGoogle Scholar
  • 51 Ferrer P, Roberts I, Sydenham E, Blackhall K, Shakur H. Anti-fibrinolytic agents in post partum haemorrhage: a systematic review. BMC Pregnancy Childbirth 2009; 9: 29
    CrossrefPubMedGoogle Scholar
  • 52 Ducloy-Bouthors AS, Jude B, Duhamel A , et al; EXADELI Study Group. High-dose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care 2011; 15 (2) R117
    CrossrefPubMedGoogle Scholar
  • 53 WHO. WHO guidelines for the management of postpartum hemorrhage and retained placenta. Geneva: WHO; 2009
    Google Scholar