Recombinant human factor VIIa prevents hysterectomy in severe postpartum hemorrhage: single center study.
OBJECTIVE
To evaluate the effectiveness of human recombinant activated factor VII (rhFVIIa, NovoSeven) in avoiding hysterectomy postpartum in the management of severe postpartum hemorrhage (PPH).


METHODS
We performed a prospective cohort study at our university tertiary care center. Patients with severe post partum hemorrhage (blood loss >2000 mL) and failed medical and uterus-preserving surgical management, were treated with intravenous bolus administration of rhVIIa. Main outcome measures were cessation of bleeding, postpartum hysterectomy and thromboembolic events.


RESULTS
In 20/22 patients included, PPH was caused primarily by uterine atony, including 7 (32%) with additional lower genital tract lesion; in two women, it was due to pathologic placentation (placenta increta, 9%). One case of amniotic fluid embolism and one woman with uterine inversion were included. Recombinant hFVIIa was successful in stopping the PPH and in preventing a hysterectomy in 20/22 women (91%). The remaining two patients with persistent bleeding despite rhFVIIa treatment, who underwent postpartum hysterectomy, had placenta increta. No thromboembolic event was noticed.


CONCLUSIONS
This study describes the largest single center series of rhFVIIa treatment for fertility preservation in severe postpartum hemorrhage published to date. Our data suggest that administration of rhFVIIa is effective in avoiding postpartum hysterectomy after conservative medical and surgical measures have failed. Although randomized studies are lacking, rhFVIIa should be considered as a second-line therapeutic option of life-threatening postpartal bleeding, in particular if preservation of fertility is warranted and hysterectomy is to be avoided.
Department of Obstetrics and Gynecology, Inselspital University Hospital, Bern, Switzerland.
Alexander W
AW
Huber
Luigi
L
Raio
Lorenzo
L
Alberio
Fabio
F
Ghezzi
Daniel V
DV
Surbek
D000328:Adult; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D059247:Fertility Preservation / Q000379:methods; D006403:Hematologic Tests; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D006473:Postpartum Hemorrhage / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D055815:Young Adult
D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa