Management of post-partum haemorrhage.
Management of post-partum haemorrhage (PPH) involves the treatment of uterine atony, evacuation of retained placenta or placental fragments, surgery due to uterine or birth canal trauma, balloon tamponade, effective volume replacement and transfusion therapy, and occasionally, selective arterial embolization. This article aims at introducing pregnancy- and haemorrhage-induced changes in coagulation and fibrinolysis and their relevant compensatory mechanisms, volume replacement therapy, optimal transfusion of blood products, and coagulation factor concentrates, and briefly cell salvage, management of uterine atony, surgical interventions, and selective arterial embolization. Special attention, respective management, and follow-up are required in women with bleeding disorders, such as von Willebrand disease, carriers of haemophilia A or B, and rare coagulation factor deficiencies. We also provide a proposal for practical instructions in the treatment of PPH.
Departments of Anaesthesia and Intensive Care, Helsinki University Hospital, Finland. jouni.ahonen@fimnet.fi
J
J
Ahonen
V
V
Stefanovic
R
R
Lassila
D000328:Adult; D001777:Blood Coagulation / Q000502:physiology; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000627:therapeutic use; D001810:Blood Volume / Q000502:physiology; D019411:Clinical Laboratory Techniques; D004621:Embolization, Therapeutic; D017707:Erythrocyte Transfusion; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage / Q000627:therapeutic use; D005342:Fibrinolysis / Q000187:drug effects; D006801:Humans; D057725:Operative Blood Salvage; D017713:Platelet Transfusion; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011247:Pregnancy; D012151:Resuscitation; D014593:Uterine Inertia / Q000503:physiopathology; D014599:Uterus / Q000187:drug effects / Q000601:surgery; D014842:von Willebrand Diseases / Q000150:complications
D001779:Blood Coagulation Factors; D005340:Fibrinogen