Emergent management of postpartum hemorrhage for the general and acute care surgeon

Abstract

BackgroundPostpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education.MethodsThe purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion.ResultsA stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm.ConclusionThe manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.

“Post partum hemorrhage: causes and management”

“…Post Partum hemorrhage may occur in 1-5% of deliveries in developed as well as in developing countries and it is still most common cause of maternal morbidity and mortality [2]. It is axiomatic that Post partum hemorrhage occur unpredictably and no patient is immune from it, it simply states that it is an equal opportunity killer.…”

“…For vaginal delivery blood loss of above 500 ml and in C-section blood loss of above 1500 ml. Another definition of PPH is that blood loss sufficient to cause hypovolemia, a 10% drop in the hematocrit or requiring transfusion of blood products (regardless of route of delivery) [2]. Prevalence of death due to PPH in Pakistan is 34% [4].…”

Acute Care/Trauma Surgeon's role in obstetrical/gynecologic emergencies (The OBCAT Alert)

“…[6] As more complex and high risk obstetrical cases are identified prenatally, the need for preparation and a multidisciplinary approach has recently been recommended. [7,8] In order to address this need, our institution developed a hospital alert system (OBCAT) with Acute Care/Trauma Services designed to coordinate hospital resources in cases of overwhelming hemorrhage.…”

An overview of women with post-partum haemorrhage in a tertiary care centre at capital of Madhya Pradesh, India

“…Another definition of PPH is that blood loss sufficient to cause hypovolemia, a 10% drop in the haematocrit or requiring transfusion of blood products (regardless of route of delivery). 2 PPH may be aggravated by pre-existing anaemia and, in such instances, the loss of a smaller volume of blood may still result in adverse clinical sequelae.…”

“…1 Post partum haemorrhage (PPH) may occur in 1-5% of deliveries in developed as well as in developing countries and it is still most common cause of maternal morbidity and mortality. 2 For vaginal delivery blood loss above 500 ml and in Csection blood loss more than 1500 ml is considered as PPH. Another definition of PPH is that blood loss sufficient to cause hypovolemia, a 10% drop in the haematocrit or requiring transfusion of blood products (regardless of route of delivery).…”