title: Massive obstetric hemorrhage: Current approach to management.
abstract: Massive obstetric hemorrhage is a major cause of maternal mortality and morbidity worldwide. It is defined (among others) as the loss of>2,500ml of blood, and is associated to a need for admission to critical care and/or hysterectomy. The relative hemodilution and high cardiac output found in normal pregnancy allows substantial bleeding before a drop in hemoglobin and/or hematocrit can be identified. Some comorbidities associated with pregnancy can contribute to the occurrence of catastrophic bleeding with consumption coagulopathy, which makes the situation even worse. Optimization, preparation, rational use of resources and protocolization of actions are often useful to improve outcomes in patients with postpartum hemorrhage. Using massive obstetric hemorrhage protocols is useful for facilitating rapid transfusion if needed, and can also be cost-effective. If hypofibrinogenemia during the bleeding episode is identified, early fibrinogen administration can be very useful. Other coagulation factors in addition to fibrinogen may be necessary during postpartum hemorrhage replacement measures in order to effectively correct coagulopathy. A hysterectomy is recommended if the medical and surgical measures prove ineffective.
authors.affiliation: Hospital Universitario La Paz, Madrid, España. Electronic address: emiguasch@hotmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Guasch
authors.affiliation: Hospital Universitario La Paz, Madrid, España.
authors.forename: F
authors.initials: F
authors.lastname: Gilsanz
mesh_terms: D001779:Blood Coagulation Factors / Q000032:analysis / Q000627:therapeutic use; D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D002585:Cesarean Section; D003422:Critical Care; D019468:Disease Management; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000628:therapy; D004621:Embolization, Therapeutic; D004876:Ergot Alkaloids / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000032:analysis / Q000627:therapeutic use; D005440:Fluid Therapy; D006474:Hemorrhagic Disorders; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007044:Hysterectomy; D010121:Oxytocin / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000628:therapy; D006473:Postpartum Hemorrhage / Q000097:blood / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood / Q000628:therapy*; D014592:Uterine Hemorrhage / Q000097:blood / Q000628:therapy*; D014593:Uterine Inertia / Q000628:therapy
chemical_list: D001779:Blood Coagulation Factors; D004876:Ergot Alkaloids; D006490:Hemostatics; D010121:Oxytocin; D005340:Fibrinogen
keywords: Bleeding; Coagulopathy; Coagulopatía; Fibrinogen; Fibrinógeno; Hemorragia; Hemorragia masiva obstétrica; Hemorragia posparto; Massive obstetric hemorrhage; Postpartum hemorrhage; Viscoelástico; Viscolastic