title: Use of recombinant activated factor VII for massive postpartum hemorrhage.
abstract: 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.
authors.affiliation: 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
authors.forename: Nazli
authors.initials: N
authors.lastname: Hossain
authors.forename: Tahir
authors.initials: T
authors.lastname: Shansi
authors.forename: Saeeda
authors.initials: S
authors.lastname: Haider
authors.forename: Nargis
authors.initials: N
authors.lastname: Soomro
authors.forename: Nusrat H
authors.initials: NH
authors.lastname: Khan
authors.forename: Ghuffrana Umer
authors.initials: GU
authors.lastname: Memon
authors.forename: Tasneem
authors.initials: T
authors.lastname: Farzana
authors.forename: Saqib
authors.initials: S
authors.lastname: Ansari
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Triche
authors.forename: Edward
authors.initials: E
authors.lastname: Kuczynski
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lockwood
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Paidas
mesh_terms: 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
chemical_list: D003029:Coagulants; D015942:Factor VIIa