How do I manage severe postpartum hemorrhage?

Butwick, Alexander J.; Lyell, Deirdre J.; Goodnough, Lawrence T.

doi:10.1111/trf.15794

Cited by 41 publications

(55 citation statements)

References 90 publications

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“…A fibrinogen level <200 is associated with severe postpartum hemorrhage 32 . If available, a viscoelastic hemostatic assay (thromboelastogram or rotational thermoelectrometry [ROTEM]) can be used to elucidate the cause of bleeding 33 . Severe uncontrolled bleeding following escalating uterotonic administration may warrant a more invasive intervention such as intrauterine balloon placement, uterine artery embolization or hysterectomy.…”

Section: Error Trap 5: Failure To Promptly Treat Uterine Atony and Hementioning

confidence: 99%

Error traps in anesthesia for fetal interventions

Ferschl

Rollins

Chatterjee

2021

Pediatric Anesthesia

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A wide range of fetal interventions are being performed worldwide to save the fetus's life, prevent permanent fetal organ damage, and allow a successful transition to extrauterine life. However, these are invasive procedures and can be associated with serious complications. This article focuses on promoting a culture of safety by highlighting five common error traps while anesthetizing patients for fetal interventions. They include failure to preserve uteroplacental perfusion and gas exchange, failure to achieve adequate uterine relaxation prior to hysterotomy, failure to monitor the fetus and prepare for fetal/neonatal resuscitation, failure to prepare for maternal hemorrhage, and failure to promptly treat uterine atony. Practical tips for avoiding these serious complications will also be discussed.

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Section: Error Trap 5: Failure To Promptly Treat Uterine Atony and Hementioning

confidence: 99%

Error traps in anesthesia for fetal interventions

Ferschl

Rollins

Chatterjee

2021

Pediatric Anesthesia

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“…Collis and Collins 21 in a review of hemostatic management of obstetric hemorrhage have proposed a Rotem‐based algorithm for management of bleeding. Similarly, Butwick and colleagues 22 has proposed a TEG‐based algorithm for obstetric hemorrhage management. Hill and colleagues 23 developed a TEG‐based algorithm which not only facilitated blood product administration but also drove other parts of resuscitation management such as placing another intravenous line and activation of a massive transfusion protocol.…”

Section: Postpartum Hemorrhage Managementmentioning

confidence: 99%

The role of viscoelastic testing in the management of the parturient

Waters

2020

Transfusion

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Viscoelastic testing is the measurement of how the viscoelastic properties of blood change as blood clots. In pregnancy, unique changes in clotting function occur overall to make the pregnant woman hypercoagulable. Viscoelastic testing may be able to play a role in guiding placement of epidural and spinal anesthetics by demonstrating enhanced coagulation function, even when there are individual parts of the coagulation system that are abnormal, for example, thrombocytopenia. These tools may also play a role in addressing the management of maternal hemorrhage, which in the United States is on the rise. This review discusses the opportunity to use viscoelastic testing in the parturient.

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“…The main advantage of this pillar is that CCTs have wide availability and a high level of quality control and reproducibility [16,18]. However, laboratory tests with lengthy turnaround times may be limited in the context of rapid hemorrhage and will not reflect current hemostatic competence of the patient [8,11,[19][20][21][22][23]. It has been well documented that PT and aPTT have low sensitivities for determining the existence of hypocoagulopathy [19,24].…”

Section: Introductionmentioning

confidence: 99%

“…However, laboratory tests with lengthy turnaround times may be limited in the context of rapid hemorrhage and will not reflect current hemostatic competence of the patient [8,11,[19][20][21][22][23]. It has been well documented that PT and aPTT have low sensitivities for determining the existence of hypocoagulopathy [19,24]. Fibrinogen levels determined by the Clauss method can show hypocoagulability sooner than PT and aPTT can, and ought to be used to supplement CCT monitoring of PPH [8,11,19,25].…”

Section: Introductionmentioning

confidence: 99%

“…It has been well documented that PT and aPTT have low sensitivities for determining the existence of hypocoagulopathy [19,24]. Fibrinogen levels determined by the Clauss method can show hypocoagulability sooner than PT and aPTT can, and ought to be used to supplement CCT monitoring of PPH [8,11,19,25]. The final pillar uses VHAs to assess hemostatic competence.…”

Section: Introductionmentioning

confidence: 99%

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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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How do I manage severe postpartum hemorrhage?

Cited by 41 publications

References 90 publications

Error traps in anesthesia for fetal interventions

Error traps in anesthesia for fetal interventions

The role of viscoelastic testing in the management of the parturient

Viscoelastic Hemostatic Assays for Postpartum Hemorrhage

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