Management of major postpartum hemorrhage

Postpartum hemorrhage (PPH) is defined by loss of greater than 500 mL of blood following vaginal delivery or 1,000 mL of blood following cesarean section, in the first 24 hours postpartum. Its incidence is up to 5% and the severe forms represent 1% of births. PPH is the first cause of obstetrical ma...

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Bibliographic Details
Published in:La Presse médicale (1983) 2014-02, Vol.43 (2), p.111-117
Main Authors: Nebout, Sophie, Merbai, Nadia, Faitot, Valentina, Keita, Hawa
Format: Article
Language:fre
Subjects:
Blood Transfusion
Delivery, Obstetric - adverse effects
Delivery, Obstetric - methods
Female
Fluid Therapy
Hemostatics - therapeutic use
Humans
Postpartum Hemorrhage - drug therapy
Postpartum Hemorrhage - therapy
Pregnancy
Vasoconstrictor Agents - therapeutic use
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Summary:Postpartum hemorrhage (PPH) is defined by loss of greater than 500 mL of blood following vaginal delivery or 1,000 mL of blood following cesarean section, in the first 24 hours postpartum. Its incidence is up to 5% and the severe forms represent 1% of births. PPH is the first cause of obstetrical maternal mortality in France and 90% of these deaths are considered as preventable. Its management is multidisciplinary (obstetricians, anesthetists, midwives, biologists and interventional radiologists), based on treatment protocols where time is a major prognosis factor. In case of failure of the initial measures (oxytocin, manual placenta removal, uterus and birth canal examination), the management of severe forms includes active resuscitation (intravenous fluids, blood transfusion, vasoactive drugs), haemostatic interventions (sulprostone, tamponnade and haemostatic suture, surgical procedures and arterial embolization) and the correction of any potential coagulopathy (administration of blood products and haemostatic agents).
ISSN:2213-0276
DOI:10.1016/j.lpm.2013.06.026