Use of recombinant activated factor VII for massive postpartum hemorrhage.
OBJECTIVE
We hypothesised that patients with massive postpartum hemorrhage (PPH), defined as blood loss >1,500 ml,may benefit from the use of activated recombinant factor VII (rFVIIa). Design. Retrospective cohort study. Setting.Department of Obstetrics & Gynaecology, Dow University of Health Sciences.


METHODS
Thirty-four women with a diagnosis of massive PPH.


METHODS
All patients with PPH who were admitted to the Department of Obstetrics &Gynecology and Surgical Intensive Care Unit of Civil Hospital Karachi, Pakistan, were included in the study. From March 2005 to October 2006, 34 patients fulfilled the criteria of massive PPH, of which 18 received rFVIIa to control bleeding, and 16 patients did not. Availability and cost of rFVIIa were the factors in drug allocation. Main outcome measures. Maternal mortality, correction of coagulopathy, the amount of blood products transfused and preservation of fertility.


RESULTS
Patients receiving rFVIIa had lower maternal mortality (5/18, 28% versus 8/16, 50%, OR: 0.04 (0.002, 0.83)), and received a lower number of packed red cell transfusions (4.0 ± 4.46 versus 9.61 ± 6.7, p value 0.007), against the comparison group. Patients receiving rFVIIa had lower activated partial thromboplastin (median: 13.0; 25-75th percentile: -25.0, -8.0, signed rank p<0.0001), and lower prothrombin times (median: -8.8; 25-75th percentile: -24.2, -4.8), after administration of drug.There was no significant difference in the rate of hysterectomy between the 2 groups (11/18 (61%) versus 6/16 (38%)). No adverse event attributable to rFVIIa was observed in the study.


CONCLUSIONS
Activated recombinant factor VII can be a lifesaving drug in patients with massive PPH.
Hossain
Nazli
N
Yale Women and Children's Center for Blood Disorders, Department of Obstetrics, Gynecology and Reproductive Sciences,Yale University School of Medicine, New Haven, CT, USA. nazlih1999@gmail.com
Shansi
Tahir
T
Haider
Saeeda
S
Soomro
Nargis
N
Khan
Nusrat H
NH
Memon
Ghuffrana Umer
GU
Farzana
Tasneem
T
Ansari
Saqib
S
Triche
Elizabeth W
EW
Kuczynski
Edward
E
Lockwood
Charles J
CJ
Paidas
Michael J
MJ
D000328:Adult; D003029:Coagulants / Q000627:therapeutic use*; D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D006473:Postpartum Hemorrhage / Q000188:drug therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
D003029:Coagulants; D015942:Factor VIIa