title: [Antenatal management for patients with increased risk of post-partum hemorrhage (excluding abnormal placentation)].
abstract: OBJECTIVE
  To describe management and screening for high-risk patients concerning post-partum hemorrhage (PPH) and antenatal management for severe anemia, thrombopenia, bleeding disorders and anticoagulant therapy.
  
  
  METHODS
  Bibliographic search restricted to French and English languages using Medline database and recommendations of medical societies.
  
  
  RESULTS
  The appropriate place for delivery should be chosen after multidisciplinary concertation based on level of risk (especially past-history of severe PPH and bleeding disorder) and easy access to blood products (Professional Consensus). Prevention for severe anemia is mainly based on oral iron supplementation (grade B). Explorations are required in case of thrombopenia<100Giga/L (grade C). Patients with bleeding disorder require the assistance of a physician skilled in hemostasis for perinatal management (grade C). Preventive anticoagulant therapy has no impact on PPH risk and perimedullar analgesia is usually authorized 12hours after last injection (grade C). Curative anticoagulant therapy slightly increases PPH risk and perimedullar analgesia is authorized only after 24hours since last injection (Professional Consensus).
  
  
  CONCLUSIONS
  Prenatal identification of high-risk patients concerning PPH implies multidisciplinary concertation to determine the most appropriate birthplace where technical and human resources are available.
authors.affiliation: Service d'anesthésie-réanimation, hôpital Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: A
authors.initials: A
authors.lastname: Fournet-Fayard
authors.affiliation: Service d'hématologie, hôpital Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: A
authors.initials: A
authors.lastname: Lebreton
authors.affiliation: Service de médecine interne, hôpital Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; EA 4681 PEPRADE, faculté de médecine, université d'Auvergne, 28, place Henri-Dunant, BP 10448, 63000 Clermont-Ferrand, France.
authors.forename: M
authors.initials: M
authors.lastname: Ruivard
authors.affiliation: Service d'anesthésie-réanimation, hôpital Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: B
authors.initials: B
authors.lastname: Storme
authors.affiliation: Centre de référence des cytopénies auto-immunes de l'adulte, service de médecine interne, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
authors.forename: B
authors.initials: B
authors.lastname: Godeau
authors.affiliation: Service d'anesthésie-réanimation, hôpital Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: M
authors.initials: M
authors.lastname: Bonnin
authors.affiliation: Pôle gynéco-obstétrique-reproduction humaine, hôpital Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; R2D2-EA7281, faculté de médecine, université d'Auvergne, 28, place Henri-Dunant, BP 10448, 63000 Clermont-Ferrand, France.
authors.forename: A
authors.initials: A
authors.lastname: Delabaere
authors.affiliation: Pôle gynéco-obstétrique-reproduction humaine, hôpital Estaing, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; R2D2-EA7281, faculté de médecine, université d'Auvergne, 28, place Henri-Dunant, BP 10448, 63000 Clermont-Ferrand, France. Electronic address: dgallot@chu-clermontferrand.fr.
authors.forename: D
authors.initials: D
authors.lastname: Gallot
mesh_terms: D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D010922:Placenta Diseases / Q000175:diagnosis / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000517:prevention & control*; D011247:Pregnancy
keywords: Anemia; Anticoagulant therapy; Anticoagulants; Anémie; Bleeding disorders; Coagulopathie; Hémorragie du post-partum; Immune thrombocytopenic purpura; Orientation; Post-partum hemorrhage; Prenatal management; Prise en charge anténatale; Purpura thrombopénique immunologique; Troubles de l’hémostase