Management of postpartum hemorrhage: how to improve maternal outcomes?

Henriquez, Dacia D. C. A.; Bloemenkamp, Kitty W. M.; Bom, Johanna G. van der

doi:10.1111/jth.14200

Cited by 33 publications

(31 citation statements)

References 109 publications

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“…1,2 Primary PPH is traditionally defined as 500 mL blood loss or more within 24 hours after delivery, independent of the mode of delivery. [6][7][8] The most frequent obstetrical causes of PPH are uterine atony, (partially) retained placenta or perineal trauma (episiotomy and/or lacerations). [6][7][8] The most frequent obstetrical causes of PPH are uterine atony, (partially) retained placenta or perineal trauma (episiotomy and/or lacerations).…”

Section: Introductionmentioning

confidence: 99%

“…3,4 PPH can further be classified as minor (500-1000 mL) or major (>1000 mL) PPH, 5 with major PPH being subdivided in moderate (1001-2000 mL) and severe (>2000 mL) PPH. [6][7][8] The most frequent obstetrical causes of PPH are uterine atony, (partially) retained placenta or perineal trauma (episiotomy and/or lacerations). A history of PPH, advanced maternal age, pre-eclampsia, macrosomia and multiple gestation are known risk factors for PPH.…”

Section: Introductionmentioning

confidence: 99%

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Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder

et al. 2019

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Introduction:Postpartum haemorrhage (PPH) is the major cause of maternal death worldwide. Haemostatic abnormalities are independently associated with a significantly increased risk for severe PPH. In this study, the value of haemostatic evaluation in women with severe PPH was explored.Aim: To investigate the occurrence of previously unknown inherited bleeding disorders in women with severe PPH.Methods: Women with severe PPH (blood loss of ≥2000 mL) between 2011 and 2017, referred to the haematology outpatient clinic for haemostatic evaluation, were retrospectively included. A bleeding disorder was diagnosed based on (inter)national guidelines, or when having a clear bleeding phenotype, not fulfilling any diagnostic criteria or laboratory abnormalities, this being classified as Bleeding of Unknown Cause (BUC). Logistic regression was used to model the association between diagnosis and obstetrical causes and risk factors for PPH. Results:In total, 85 women with PPH were included. In 23% (n = 16), a mild bleeding disorder was diagnosed, including low von Willebrand factor (Low VWF 8/16), platelet function disorders (PFD 5/16), BUC (2/16) and von Willebrand disease type 1 (1/16). No significant associations were found between obstetrical causes or risk factors for PPH and the presence of a bleeding disorder. Conclusion:In 23% of women with severe PPH, a mild bleeding disorder was diagnosed, independent of obstetrical causes or risk factors for PPH. This implies that severe PPH can be the first clinical symptom of an inherited bleeding disorder. Therefore, to optimize clinical management, haemostatic evaluation after severe PPH is recommended. K E Y W O R D Shaemostasis, inherited blood coagulation disorders, postpartum haemorrhage, von Willebrand disease, women's health

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder

et al. 2019

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“…38,156 Potential use of Precision-Based Medicine in MAC and TIC Large randomized controlled trials regarding the empiric management of bleeding trauma and obstetrical patients have been met with differing levels of acceptances as the histories of the CRASH-2 and WOMAN trials have shown. 27,[157][158][159][160][161][162][163] Because of the unintended consequence of "one-size-fits-all" randomized controlled trial philosophy touted for the advancement of evidence-based clinical science, it is more difficult to engage in smaller proof-of-concept studies that evaluate the influence of specific pathophysiological derangements and phenotypes on clinical outcomes. 164,165 The concept of precision-based medicine has been developed to allow for the integration of epidemiologic findings from randomized controlled trials with select patient-group-specific clinical findings.…”

Section: The Spectrum Of Macmentioning

confidence: 99%

Use of Viscoelastography in Malignancy-Associated Coagulopathy and Thrombosis: A Review

Walsh

Moore

et al. 2019

Semin Thromb Hemost

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The relationship between malignancy and coagulopathy is one that is well documented yet incompletely understood. Clinicians have attempted to quantify the hypercoagulable state produced in various malignancies using common coagulation tests such as prothrombin time, activated partial thromboplastin time, and platelet count; however, due to these tests' focus on individual aspects of coagulation during one specific time point, they have failed to provide clinicians the complete picture of malignancy-associated coagulopathy (MAC). Viscoelastic tests (VETs), such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are whole blood analyses that have the advantage of providing information related to the cumulative effects of plasma clotting factors, platelets, leukocytes, and red cells during all stages of the coagulation and fibrinolytic processes. VETs have gained popularity in the care of trauma patients to objectively measure trauma-induced coagulopathy (TIC), but the utility of VETs remains yet unrealized in many other medical specialties. The authors discuss the similarities and differences between TIC and MAC, and propose a mechanism for the hypercoagulable state of MAC that revolves around the thrombomodulin–thrombin complex as it switches between activating the protein C anticoagulation pathway or the thrombin activatable fibrinolysis inhibitor coagulation pathway. Additionally, they review the current literature on the use of TEG and ROTEM in patients with various malignancies. Although limited research is currently available, early results demonstrate the utility of both TEG and ROTEM in the prediction of hypercoagulable states and thromboembolic complications in oncologic patients.

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“…Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide [1][2][3], and the incidence has increased in many countries despite improvements in obstetric protocols to prevent and treat severe hemorrhage [4][5][6][7]. Specific intervention points and management strategies to define and treat coagulopathy associated with PPH are not uniform [8].…”

Section: The Utilization Of Viscoelastic Testing To Guide Blood Compomentioning

confidence: 99%

“…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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Management of postpartum hemorrhage: how to improve maternal outcomes?

Cited by 33 publications

References 109 publications

Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder

Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder

Use of Viscoelastography in Malignancy-Associated Coagulopathy and Thrombosis: A Review

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

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