Finding Better Ways to Prevent Postpartum Hemorrhage

Shakur-Still, Haleema; Roberts, Ian

doi:10.1056/nejme1808500

Cited by 6 publications

(3 citation statements)

References 11 publications

(7 reference statements)

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“…These RCTs found improved mortality when TXA was administered within 3 h of the start of bleeding due to trauma and PPH [117,118]. Ensuing publications have identified variance in these conclusions, and for this reason, these trials have become a source of controversy [5,8,11,15,111,[119][120][121][122][123][124][125][126][127][128][129][130][131][132]. However, it has also been suggested that fibrinolytic parameters of VHAs are not reliable for guiding the administration of TXA in PPH patients [73,109,110].…”

Section: Tranexamic Acidmentioning

confidence: 99%

Viscoelastic Hemostatic Assays for Postpartum Hemorrhage

Liew-Spilger

Sorg

Brenner

et al. 2021

JCM

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This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.

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Section: Tranexamic Acidmentioning

confidence: 99%

Viscoelastic Hemostatic Assays for Postpartum Hemorrhage

Liew-Spilger

Sorg

Brenner

et al. 2021

JCM

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show abstract

“…These large well-designed RCTs suggest that the utilization of TXA within 3 hours of bleeding, either from trauma or PPH, improved mortality. Subsequent studies have suggested that knowledge gaps in the CRASH-2 Trial and problems in defining PPH have made these trials a source of considerable and interesting discussion [7,[63][64][65][66][67][68][69][70][71][72][73][74][75][76][77]. For the other prohemostatic agents, the utilization of soluble fibrinogen in Europe and cryoprecipitate in the United States is guided by VETs and Clauss fibrinogen [10].…”

Section: Platelet Functionmentioning

confidence: 99%

The Utilization of Viscoelastic Testing to Guide Blood Component Therapy and Adjunctive Hemostatic Therapy for Postpartum Hemorrhage: A Narrative Review

Shariff

Lune

et al. 2019

COGO

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This narrative review discusses the history of the pathophysiologic principles and utilization of point-of-care (POC) viscoelastic tests (VETs) in the definition and treatment of postpartum hemorrhage (PPH). This paper addresses the epidemiology of PPH, describes the hemostatic changes that occur in pregnancy and in PPH, and demonstrates the utilization of viscoelastic testing in the identification and treatment of patients with PPH. Additionally, a description of rotational thromboelastometry (ROTEM) and thromboelastography (TEG), the two most commonly used VETs, is detailed in this paper. VETs have only recently been used to guide blood component therapy (BCT) in trauma in the last decade. The recent increased utilization of VETs to guide BCT in PPH is following a similar trend with a delay of ten years. In a similar fashion to the trauma literature, which expanded greatly within this last decade, the literature concerning the use of VETs in PPH has also increased in the last few years. However, because of differing pathophysiologies associated with the coagulopathy of PPH verses traumatic-induced coagulopathy (TIC), utilization of VETs has been more refined and focused on the VETs’ capacity to determine low fibrinogen and to guide the utilization of blood components and prohemostatic agents. The identification and treatment of PPH depends on clinical parameters, conventional coagulation tests (CCTs) including Clauss fibrinogen, and VETs. Successful treatment of PPH will no doubt include utilization of all three strategies with an increasing utilization of VETs in the future.

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“…Since 1870s, peripartum hysterectomy has been performed to manage life-threatening postpartum haemorrhage (PPH) and uterine sepsis [1]. When bleeding cannot be controlled by conservative therapies, hysterectomy is performed as the definitive treatment and a life-saving procedure [2,3]. However, hysterectomy leads to the loss of fertility for women and can cause maternal morbidity and mortality [4].…”

Section: Introductionmentioning

confidence: 99%

Development of a Nomogram for Preoperative Prediction of Emergency Peripartum Hysterectomy with Postpartum Haemorrhage: A Chinese-Population-Based Study

He¹,

Cai²,

Li³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Objective: To develop and validate a model to predict the incidence of emergency peripartum hysterectomy (EPH) due to postpartum haemorrhage (PPH) from the time of delivery to 6 weeks postpartumin the duration of caesarean section (C-section). Methods: There were 627 patients with PPH including in this retrospective study from 2015 to 2019. Among these patients, 439 patients were divided into the model development group and 188 patients were divided into the validation group. The validation group was constructed for external validation in the usage of bootstrap resampling. The least absolute shrinkage and selection operator (LASSO) regression model was used to reduce the data dimension, and select features and independent risk factors. Results: In total, the incidence rate of PPH and EPH was 7.53% (2145/284,912) and 2.73‰ (78/28,491) among the 28,491 patients with C-section, respectively. The results of LASSO regression indicated that prothrombin time decrease at 60 minutes after C-section (odds ratio (OR) = 1.823, 95% confidence interval (CI): 1.171-2.839) and placenta previa (OR = 5.374, 95% CI: 2.751-10.393) were positively associated with EPH in this study, while gestational age at termination (OR = 0.959, 95% CI: 0.930-0.989) and albumin decrease at 60 minutes after C-section (OR = 0.907, 95% CI: 0.843-0.976) had negative association with EPH. Besides, we found that the C-index was 0.896 for the primary cohort and 0.899 for the validation cohort in the prediction nomogram, respectively. Conclusions: In this retrospective study, an EPH nomogram within several risk factors, which was constructed by LASSO regression, can be contributed to effectively predict the risk of EPH in patients with PPH during C-section. In addition, a significant association is observed between abnormal placenta and peripartum hysterectomy.

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Finding Better Ways to Prevent Postpartum Hemorrhage

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Cited by 6 publications

References 11 publications

Viscoelastic Hemostatic Assays for Postpartum Hemorrhage

Viscoelastic Hemostatic Assays for Postpartum Hemorrhage

The Utilization of Viscoelastic Testing to Guide Blood Component Therapy and Adjunctive Hemostatic Therapy for Postpartum Hemorrhage: A Narrative Review

Development of a Nomogram for Preoperative Prediction of Emergency Peripartum Hysterectomy with Postpartum Haemorrhage: A Chinese-Population-Based Study

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