Open AccessHemostatic resuscitation in postpartum hemorrhage – a supplement to surgery
Author(s) -
Ekelund Kim,
Hanke Gabriele,
Stensballe Jakob,
Wikkelsøe Anne,
Albrechtsen Charlotte Krebs,
Afshari Arash
Publication year - 2015
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12607
Subject(s) - medicine , tranexamic acid , uterotonic , thromboelastometry , thromboelastography , desmopressin , hemostasis , antifibrinolytic , anesthesia , fibrinolysis , resuscitation , coagulopathy , recombinant factor viia , intensive care medicine , afibrinogenemia , surgery , fibrinogen , coagulation , oxytocin , blood loss
Background Postpartum hemorrhage is a potentially life‐threatening albeit preventable condition that persists as a leading cause of maternal death. Identification of safe and cost‐effective hemostatic treatment options remains crucial as a supplement to surgery and uterotonic agents. Objective This review summarizes the background, current evidence and recommendations with regard to the role of fibrinogen, tranexamic acid, prothrombin complex concentrate, desmopressin, and recombinant factor VII a in the treatment of patients with postpartum hemorrhage. The benefits and evidence behind traditional standard laboratory tests and viscoelastic hemostatic assays, i.e. thromboelastography TEG ® and thromboelastometry ROTEM ® , are discussed. In addition we assess and elaborate on the current paradigm and evidence for transfusion of these patients. Data sources Publications between 1994 and 2014 were identified from PubMed, EMBASE , Cochrane Library databases, and ClinicalTrial.gov. Results Viscoelastic hemostatic assays were found to provide a real‐time continuum of coagulation and fibrinolysis when introduced as a supplement in transfusion management of postpartum hemorrhage. Fibrinogen should be considered when hypofibrinogenemia is identified. Early administration of 1–2 g tranexamic acid is recommended, followed by an additional dose in cases of ongoing bleeding. Uncontrolled hemorrhage requires early balanced transfusion. Conclusion Despite the lack of conclusive evidence for optimal hemostatic resuscitation in postpartum hemorrhage, the use of viscoelastic hemostatic assays, fibrinogen, tranexamic acid and balanced transfusion therapy may prove to be potentially pivotal in the treatment of postpartum hemorrhage.