Abstract
Peripartum maternal death is a tragedy that claims lives of young women and leaves behind a devastated family. Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, and it is all the more tragic as, among causes of maternal mortality, death from PPH appears preventable in many, if not most cases, at least in resource rich countries [1–3]. Management of PPH involves an interdisciplinary team of midwives, obstetricians, anesthetists and transfusion specialists. The scope of this review is to highlight current trends in epidemiology, medical treatment and the current controversy on transfusion protocols, blood component therapy or specific pharmacological interventions on the coagulation system.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Berg CJ, Harper MA, Atkinson SM et al (2005) Preventability of pregnancy-related deaths: results of a state-wide review. Obstet Gynecol 106:1228–1234
Lewis G (2007) The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer – 2003–2005. The seventh report on confidential enquiries into maternal deaths in the United Kingdom. Available at: http://www.publichealth.hscni.net/sites/default/files/Saving%20Mothers'%20Lives%202003-05%20.pdf. Accessed October 2012
Knight M, Callaghan WM, Berg C et al (2009) Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth 9:55
Thaler I, Manor D, Itskovitz J et al (1990) Changes in uterine blood flow during human pregnancy. Am J Obstet Gynecol 162:121–125
Sloan NL, Durocher J, Aldrich T et al (2010) What measured blood loss tells us about postpartum bleeding: a systematic review. BJOG 117:788–800
Stafford I, Dildy GA, Clark SL et al (2008) Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol 199:519.e1–519.e7
Gahres EE, Albert SN, Dodek SM (1962) Intrapartum blood loss measured with Cr 51-tagged erythrocytes. Obstet Gynecol 19:455–462
Carroli G, Cuesta C, Abalos E et al (2008) Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 22:999–1012
Biguzzi E, Franchi F, Ambrogi F et al (2012) Risk factors for postpartum hemorrhage in a cohort of 6011 Italian women. Thromb Res 129:e1–e7
Clark SL, Hankins GDV (2012) Preventing maternal death: 10 clinical diamonds. Obstet Gynecol 119:360–364
Rudra A, Chatterjee S, Sengupta S et al (2010) Management of obstetric hemorrhage. Middle East J Anesthesiol 20:499–507
Nielson EC, Varner MW, Scott JR (1991) The outcome of pregnancies complicated by bleeding during the second trimester. Surg Gynecol Obstet 173:371–374
Justus Hofmeyr G, Say L, Metin Gülmezoglu A (2005) Systematic Review: WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG 112:1221–1228
Guise JM (2004) Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section. BMJ 329:19–25
Farinelli CK, Hameed AB (2012) Cardiopulmonary resuscitation in pregnancy. Cardiol Clin 30:453–461
Mercier FJ, Van de Velde M (2008) Major obstetric hemorrhage. Anesthesiol Clin 26:53–66
Khan KS, Wojdyla D, Say L et al (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367:1066–1074
Wen SW, Huang L, Liston R et al (2005) Severe maternal morbidity in Canada, 1991–2001. CMAJ 173:759–764
Waterstone M, Bewley S, Wolfe C (2001) Incidence and predictors of severe obstetric morbidity: case-control study. BMJ 322:1089–1093
Hogan MC, Foreman KJ, Naghavi M et al (2010) Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 375:1609–1623
Creanga AA, Berg CJ, Syverson C et al (2012) Race, ethnicity, and nativity differentials in pregnancy-related mortality in the United States: 1993–2006. Obstet Gynecol 120:261–268
Lutomski JE, Byrne BM, Devane D et al (2012) Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG 119:306–314
Bateman BT, Berman MF, Riley LE et al (2010) The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 110:1368–1373
Berg CJ, Callaghan WM, Syverson C et al (2010) Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol 116:1302–1309
Schutte JM, Steegers EAP, Schuitemaker NWE et al (2010) Rise in maternal mortality in the Netherlands. BJOG 117:399–406
Rath W, Surbek D, Kainer F, et al (2008) [Diagnosis and Therapy of Peripartum Hemorrhage]. Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Available at: http://www.dggg.de/fileadmin/public_docs/Leitlinien/3-3-5-peripartale-blutungen-2010.pdf. Accessed October 2012
Gayat E, Resche-Rigon M, Morel O et al (2011) Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study. Intensive Care Med 37:1816–1825
Naef 3rd RW, Chauhan SP, Chevalier SP et al (1994) Prediction of hemorrhage at cesarean delivery. Obstet Gynecol 83:923–926
Prata N, Hamza S, Bell S et al (2011) Inability to predict postpartum hemorrhage: insights from Egyptian intervention data. BMC Pregnancy Childbirth 11:97
Begley CM, Gyte GML, Devane D, et al (2011) Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev CD007412
Leduc D, Senikas V, Lalonde AB et al (2009) Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. J Obstet Gynaecol Can 31:980–993
Rogers J, Wood J, McCandlish R et al (1998) Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial. Lancet 351:693–699
B-Lynch C, Keith LG, Lalonde AB, Karoshi M (2006) A Textbook of Postpartum Hemorrhage: A Comprehensive Guide to Evaluation, Management and Surgical Intervention. Sapiens Publishing, Duncow
Leong BSH, Chua GSW (2011) Quality of resuscitation in hospitals. Singapore Med J 52:616–619
Drife J (1997) Management of primary postpartum haemorrhage. BJOG 104:275–277
Sihler KC, Napolitano LM (2010) Complications of massive transfusion. Chest 137:209–220
Crofts JF, Ellis D, Draycott TJ et al (2007) Change in knowledge of midwives and obstetricians following obstetric emergency training: a randomised controlled trial of local hospital, simulation centre and teamwork training. BJOG 114:1534–1541
Merién AER, van de Ven J, Mol BW et al (2010) Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. Obstet Gynecol 115:1021–1031
Rizvi F, Mackey R, Barrett T et al (2004) Successful reduction of massive postpartum haemorrhage by use of guidelines and staff education. BJOG 111:495–498
Siassakos D, Crofts JF, Winter C et al (2009) The active components of effective training in obstetric emergencies. BJOG 116:1028–1032
Su LL, Chong YS (2012) Massive obstetric haemorrhage with disseminated intravascular coagulopathy. Best Pract Res Clin Obstet Gynaecol 26:77–90
Vercauteren M, Palit S, Soetens F et al (2009) Anaesthesiological considerations on tocolytic and uterotonic therapy in obstetrics. Acta Anaesthesiol Scand 53:701–709
Magalhaes JKRS, Carvalho JCA, Parkes RK et al (2009) Oxytocin pretreatment decreases oxytocin-induced myometrial contractions in pregnant rats in a concentration-dependent but not time-dependent manner. Reprod Sci 16:501–508
Dyer RA, Butwick AJ, Carvalho B (2011) Oxytocin for labour and caesarean delivery: implications for the anaesthesiologist. Curr Opin Anaesthesiol 24:255–261
Gogarten W, Van Aken H, Kessler P et al (2009) Durchfuehrung von Analgesie- und Anaesthesieverfahren in der Geburtshilfe. 2. Überarbeitete Empfehlungen der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin. Anaesth Intensivmed 50:S502–S507
Thomas TA, Cooper GM (2002) Maternal deaths from anaesthesia: An extract from Why mothers die 1997–1999, the Confidential Enquiries into Maternal Deaths in the United Kingdom. Br J Anaesth 89:499–508
Langesæter E, Rosseland LA, Stubhaug A (2011) Haemodynamic effects of oxytocin in women with severe preeclampsia. Int J Obstet Anesth 20:26–29
Sweeney G, Holbrook AM, Levine M et al (1990) Pharmacokinetics of carbetocin, a long-acting oxytocin analogue, in nonpregnant women. Curr Therapeutic Res 47:528–540
Rydén G, Sjöholm I (1969) Half-life of oxytocin in blood of pregnant and non-pregnant women. Acta Endocrinol 61:425–431
Su LL, Chong YS, Samuel M (2012) Carbetocin for preventing postpartum haemorrhage. Cochrane Database Syst Rev CD005457
Gohil JT, Tripathi B (2011) A study to compare the efficacy of misoprostol, oxytocin, methyl-ergometrine and ergometrine-oxytocin in reducing blood loss in active management of 3rd stage of labor. J Obstet Gynaecol India 61:408–412
Gibbins KJ, Albright CM, Rouse DJ (2012) Postpartum hemorrhage in the developed world: whither misoprostol? Am J Obstet Gynecol (in press)
Borgman MA, Spinella PC, Perkins JG et al (2007) The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma 63:805–813
Cotton BA, Au BK, Nunez TC et al (2009) Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. J Trauma Acute Care Surg 66:41–49
Onwuemene O, Green D, Keith L (2012) Postpartum hemorrhage management in 2012: Predicting the future. Int J Gynecol Obst 119:3–5
Pacheco LD, Saade GR, Gei AF et al (2011) Cutting-edge advances in the medical management of obstetrical hemorrhage. Am J Obstet Gynecol 205:526–532
Gutierrez MC, Goodnough LT, Druzin M et al (2012) Postpartum hemorrhage treated with a massive transfusion protocol at a tertiary obstetric center: a retrospective study. Int J Obstet Anesth 21:230–235
Snegovskikh D, Clebone A, Norwitz E (2011) Anesthetic management of patients with placenta accreta and resuscitation strategies for associated massive hemorrhage. Curr Opin Anaesthesiol 24:274–281
Callum JL, Rizoli S (2012) Plasma transfusion for patients with severe hemorrhage: what is the evidence? Transfusion 52(Suppl 1):30S–37S
Gogarten W (2011) Postpartum hemorrhage-an update. Anasthesiol Intensivmed Notfallmed Schmerzther 46:508–514
Cerneca F, Ricci G, Simeone R et al (1997) Coagulation and fibrinolysis changes in normal pregnancy: Increased levels of procoagulants and reduced levels of inhibitors during pregnancy induce a hypercoagulable state, combined with a reactive fibrinolysis. Eur J Obstet Gynecol Reprod Biol 73:31–36
Macphail S, Talks K (2004) Massive post-partum haemorrhage and management of disseminated intravascular coagulation. Curr Opin Obstet Gynecol 14:123–131
Pötzsch B, Ivaskevicius V (2011) Haemostasis management of massive bleeding. Hämostaseologie 31:15–20
Rugeri L, Levrat A, David JS et al (2007) Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography. J Thromb Haemost 5:289–295
Brenner B (2004) Haemostatic changes in pregnancy. Thromb Res 114:409–414
Epiney M, Boehlen F, Boulvain M et al (2005) D-dimer levels during delivery and the postpartum. J Thromb Haemost 3:268–271
Shakur H, Roberts I, Bautista R et al (2010) 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 376:23–32
Ker K, Edwards P, Perel P, Shakur H, Roberts I (2012) Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 344:e3054
Rossaint R, Bouillon B, Cerny V et al (2010) Management of bleeding following major trauma: an updated European guideline. Crit Care 14:R52
Novikova N, Hofmeyr GJ (2007) Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev CD007872
Gungorduk K, Yıldırım G, Asıcıoğlu O et al (2011) Efficacy of intravenous tranexamic acid in reducing blood loss after elective cesarean section: a prospective, randomized, double-blind, placebo-controlled study. Am J Perinatol 28:233–240
Movafegh A, Eslamian L, Dorabadi A (2011) Effect of intravenous tranexamic acid administration on blood loss during and after cesarean delivery. BJOG 115:224–226
Ferrer P, Roberts I, Sydenham E et al (2009) Anti-fibrinolytic agents in post partum haemorrhage: a systematic review. BMC Pregnancy Childbirth 9:29
Ducloy-Bouthors A-S, Jude B, Duhamel A et al (2011) High-dose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care 15:R117
Fergusson DA, Hébert PC, Mazer CD et al (2008) A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 358:2319–2331
Peitsidis P, Kadir RA (2011) Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum. Expert Opin Pharmacother 12:503–516
Lier H, Rath W (2011) Current interdisciplinary recommendations for the management of severe postpartum hemorrhage (PPH). Geburtshilfe und Frauenheilkunde 71:577–588
WHO (2009) WHO Guidelines for the Management of Postpartum Hemorrhage and Retained Placenta. WHO Press, Geneva
Charbit B, Mandelbrot L, Samain E et al (2007) The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost 5:266–273
Kratz A, Ferraro M, Sluss PM et al (2004) Laboratory reference values. N Engl J Med 351:1548–1564
Mercier FJ, Bonnet MP (2010) Use of clotting factors and other prohemostatic drugs for obstetric hemorrhage. Curr Opin Anaesthesiol 23:310–316
Cortet M, Deneux-Tharaux C, Dupont C et al (2012) Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. Br J Anaesth 108:984–989
Bell SF, Rayment R, Collins PW et al (2010) The use of fibrinogen concentrate to correct hypofibrinogenaemia rapidly during obstetric haemorrhage. Int J Obstet Anesth 19:218–223
Ahonen J, Stefanovic V, Lassila R (2010) Management of post-partum haemorrhage. Acta Anaesthesiol Scand 54:1164–1178
Wood AJJ, Mannucci PM (1998) Hemostatic drugs. N Engl J Med 339:245–253
Lin Y, Stanworth S, Birchall J, et al (2011) Recombinant factor VIIa for the prevention and treatment of bleeding in patients without haemophilia. Cochrane Database Syst Rev CD005011
Ahonen J, Jokela R, Korttila K (2007) An open non-randomized study of recombinant activated factor VII in major postpartum haemorrhage. Acta Anaesth Scand 51:929–936
Boehlen F, Morales MA, Fontana P et al (2004) Prolonged treatment of massive postpartum haemorrhage with recombinant factor VIIa: case report and review of the literature. BJOG 111:284–287
Segal S, Shemesh IY, Blumental R et al (2004) The use of recombinant factor VIIa in severe postpartum hemorrhage. Acta Obstet Gynecol Scand 83:771–772
Bundesärztekammer, [German Medical Association] (2009) Cross-sectional guidelines for therapy with blood components and plasma derivatives. Available at: https://www.iakh.de/tl_files/iakh/public/richtlinien/Querschnittsleitlinie_4._Auflage_-_englisch_05.01.2011%20copy.pdf. Accessed October 2012
McLintock C, James AH (2011) Obstetric hemorrhage. J Thromb Haemost 9:1441–1451
Van De Velde M (2008) Massive obstetric hemorrhage due to abnormal placentation: uterotonic drugs, cell salvage and activated recombinant factor seven. Acta Anaesthesiol Belg 59:197–200
Welsh A, Mclintock C, Gatt S et al (2008) Guidelines for the use of recombinant activated factor VII in massive obstetric haemorrhage. Aust NZ J Obstet Gynaecol 48:12–16
Vincent JL, Rossaint R, Riou B et al (2006) Recommendations on the use of recombinant activated factor VII as an adjunctive treatment for massive bleeding – a European perspective. Crit Care 10:R120
Teig M, Harkness M, Catling S et al (2007) Survey of cell salvage use in obstetrics in the UK. Int J Obstet Anesth 16(Suppl 1):30
Tevet A, Grisaru-Granovsky S, Samueloff A et al (2012) Peripartum use of cell salvage: a university practice audit and literature review. Arch Gynecol Obstet 285:281–284
Allam J, Cox M, Yentis SM (2008) Cell salvage in obstetrics. Int J Obstet Anesth 17:37–45
Huissoud C, Carrabin N, Audibert F et al (2009) Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry. BJOG 116:1097–1102
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Kiefer, N., Weber, S. (2013). Postpartum Hemorrhage. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2013. Annual Update in Intensive Care and Emergency Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35109-9_2
Download citation
DOI: https://doi.org/10.1007/978-3-642-35109-9_2
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-35108-2
Online ISBN: 978-3-642-35109-9
eBook Packages: MedicineMedicine (R0)