The clinical presentation of spontaneous rupture of utero-ovarian blood vessels is not specific and clinical examination and ultrasonographic scanning may be insufficient for diagnosis. Once the diagnosis of spontaneous haematoperitoneum in pregnancy is established, emergency laparotomy is indicated. Following caesarean delivery, it is necessary to establish surgical haemostasis. There are some authors who suggest leaving the pregnancy intact in cases when the foetus is not viable, although one must have in mind the possibility of recurrent bleeding. The safety of this procedure requires further investigation. It is necessary to have in mind the possibility of blood vessel rupture in all cases of abdominal pain and hypotension of unknown origin during pregnancy.
INTRODUCTION. Massive obstetric bleeding is the most common cause of maternal
mortality and morbidity. The first step in treatment of these patients is
establishing the adequate circulatory volume. The primary goal of therapy is
to identify and remove the cause of bleeding, with appropriate symptomatic
and substitution therapy. Human recombinant activated factor VII (rFVIIa) is
officially registered for the treatment of patients suffering from
haemophilia with inhibitors. Its use has also proved successful in other
congenital and acquired coagulopathies and in patients with acute
non-haemophilic bleeding. A special significance is given to the application
of rFVIIa in cases of obstetric haemorrhage, in order to avoid postpartum
hysterectomy and occurrence of complications of haemorrhagic shock in
obstetrics. OBJECTIVE. The aim of this study is to show our experience and
results of the use of rFVIIa in the treatment of patients with massive
postpartum bleeding. METHOD. The retrospective study encompassed six patients
with primary postpartum haemorrhage treated with rFVIIa at our institution in
the period from 2005 to 2007. RESULTS. The treated patients were divided into
two groups. In the first group, there were three patients who underwent
hysterectomy and who received rFVIIa over 24 hours after delivery. The second
group consisted of three patients who received rFVIIa in the first 24 hours
after delivery, before we decided to perform hysterectomy. The application of
rFVIIa led to successful cessation of bleeding in all patients. Relevant side
effects were not registered. CONCLUSION. The administration of rFVIIa in
obstetrics should be considered for each patient before decision to apply
hysterectomy, and it should certainly be applied in patients who want to
preserve the uterus and fertile capability. According to our experience, in
cases of postpartum hemorrhagia rFVIIa is to be administered in intravenous
bolus doses of at least 90 mcg/kg, at least 6 hours after the onset of
bleeding. rFVIIa is not an alternative to adequate surgical haemostasis;
therefore, it needs to be administered after its detailed revision.
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