Current Concepts in the Treatment of Major Obstetric Hemorrhage
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OBSTETRICAL ANESTHESIA (LR LEFFERT, SECTION EDITOR)
Current Concepts in the Treatment of Major Obstetric Hemorrhage Matthew Schwartz • Anasuya Vasudevan
Published online: 27 September 2013 Springer Science + Business Media New York 2013
Abstract Major obstetric hemorrhage (MOH) is one of the top three causes of morbidity and mortality in the United States and the main cause of maternal death in the developing world. The growing number of multiple cesarean deliveries, augmented labors, pregnant women of advanced maternal age, maternal obesity, or abnormal placentation have a direct correlation with the observed increase in peripartum blood loss. As awareness of the morbidity and mortality associated with MOH increases, new diagnostic and therapeutic modalities are evolving to address this public health threat. This review presents current opinions and recent clinical advances in the diagnosis and management of, and resuscitation after, massive obstetric hemorrhage. Keywords Obstetric hemorrhage Placenta accretae Uterotonics Massive transfusion Fibrinogen
Canada, Australia, and France, the incidence of obstetric hemorrhage is increasing [3]. Despite the magnitude of this global problem, there is no uniform consensus on the definition of massive obstetric hemorrhage (MOH). In general, definitions of MOH are based on the volume of blood lost or the number transfusions needed over a given time period. Usually, the term MOH refers to clinical situations in which there is ongoing blood loss and failure to institute immediate resuscitative measures could result in maternal death. The population at risk of MOH should be identified early. Active resuscitation should be initiated rapidly and the etiology of hemorrhage should be pursued and corrected. Currently, clinical shortcomings and lack of resources in many parts of the world interfere with delivery of peripartum care, and obstetric hemorrhage is still a leading preventable cause of tragic maternal morbidity and mortality.
Introduction Postpartum hemorrhage (PPH) is a leading cause of maternal death worldwide; it is estimated to contribute to at least 30 % of all maternal deaths each year [1, 2]. Even in highly developed countries, for example the US, UK,
M. Schwartz A. Vasudevan (&) Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA e-mail: [email protected] M. Schwartz e-mail: [email protected]
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Definition of Obstetric Hemorrhage There is no unifying definition of MOH. In a singleton pregnancy, 500 mL blood loss during vaginal delivery and up to 1,000 mL blood loss during cesarean delivery has been accepted as the traditional norm. The generally accepted definition of massive hemorrhage is one or more of the following: 1. 2. 3. 4.
Estimated blood loss of 2,500 mL or more. Need to treat coagulopathy. Replacement of entire blood volume or transfusion of more than 10 units of blood in 24 h. Replacement of 50 % of circul
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