title: Guidelines for the use of recombinant activated factor VII in massive obstetric haemorrhage.
abstract: Recombinant activated factor VII (rFVIIa) is emerging as a novel therapy for the treatment of life or fertility-threatening post-partum haemorrhage (PPH) unresponsive to standard therapy that in some cases may prevent the need for peripartum hysterectomy. The level of evidence to date for use of rFVIIa in PPH is limited to case reports and case series with one nonrandomised study. No high-quality randomised controlled trials have been published at this stage, precluding a quality systematic review. Guidelines have been published for the use of rFVIIa in non-obstetric haemorrhage, though to date none are available for PPH. A multidisciplinary group of Australian and New Zealand clinicians from the fields of obstetrics, anaesthesia and haematology, who have both clinical experience in and/or knowledge of rFVIIa was convened by the manufacturer. This group produced an opinion and guideline based on their experience and the published international literature on the use of rFVIIa. This is intended to be used as a guideline and algorithm for the use of rFVIIa, though any use should be tailored to local practice and resources.
authors.affiliation: Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia. alecwelsh@gmail.com
authors.forename: Alec
authors.initials: A
authors.lastname: Welsh
authors.forename: Claire
authors.initials: C
authors.lastname: McLintock
authors.forename: Stephen
authors.initials: S
authors.lastname: Gatt
authors.forename: David
authors.initials: D
authors.lastname: Somerset
authors.forename: Phillip
authors.initials: P
authors.lastname: Popham
authors.forename: Robert
authors.initials: R
authors.lastname: Ogle
mesh_terms: D000328:Adult; D000465:Algorithms; D001777:Blood Coagulation / Q000502:physiology; D001780:Blood Coagulation Tests; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D006473:Postpartum Hemorrhage / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D011247:Pregnancy; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa