Postpartale Hämorrhagie

Helmer, Philipp; Schlesinger, Tobias; Hottenrott, Sebastian; Wöckel, Achim; Sitter, Magdalena; Skazel, Tobias; Wurmb, Thomas; Türkmeneli, Ismail; Härtel, Christoph; Hofer, Stefan; Alkatout, İbrahim; Messroghli, Leila; Girard, Thierry; Meybohm, Patrick; Kranke, Peter

doi:10.1007/s00101-022-01098-8

Cited by 6 publications

(3 citation statements)

References 42 publications

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“…This approach may produce a similar effect to uterine dressings but is more effective and easier to use, and makes hysterectomy unnecessary. 18 When persistent postpartum uterine bleeding does not respond to standard therapy adequately, but the patient is hemodynamically stable and can tolerate 1-2 hours until bleeding is controlled, angiography should be considered before surgical intervention. The catheter is inserted by the radiologist into the abdominal aorta and an aortogram is taken to locate the distal bleeding site.…”

Section: Specific Resuscitation Of Obstetric Hemorrhagementioning

confidence: 99%

“…The catheter is directed into the affected vessel or the internal iliac artery, and blood flow is stopped by embolization. 18 The loss of blood volume, relative to normal blood volume respective towards each patient's age (70 ml/kg in adults with ideal body weight, 60 ml/kg in elderly, and 80-90 ml/kg in children), within 24 hours defined as massive blood loss. Another alternative definition is the loss of 50% of blood volume within three hours or a rate of loss greater than 150 ml per minute.…”

Section: Specific Resuscitation Of Obstetric Hemorrhagementioning

confidence: 99%

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The Role Anesthesiologist in Management of Obstetric Haemorrhage: A Literature Review

Shantikaratri,

Isngadi

2024

MACC

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Hemorrhagic shock in obstetrics is still a major cause of maternal mortality and morbidity worldwide. Recognition of bleeding in obstetric patients is complicated by the normal physiologic changes that occur during pregnancy. Visual estimates of blood loss are often erroneous and underestimated because of contamination with amniotic fluid, or internal or hidden blood loss. Thus, careful clinical observation and a high index of suspicion are required for the early detection and management of obstetric hemorrhage. The usage of ultrasound (US) is considered as the first line method for detecting abnormal condition which might serve as a predictor for hemorrhagic shock. Despite of careful risk assessment given, obstetric-specific bleeding protocols, such as resuscitation and blood transfusion, are required to facilitate the integration and timely escalation interventions. The intervention of choice for hemorrhagic shock in obstetrics encompasses a wide variety of options, such as the usage of tranexamic acid, cell salvage, resuscitative endovascular balloon occlusion of the aorta (REBOA), anesthetic management, and surgical, as well as radiological provides multiple available approach, each with their own risk and advantages. The purpose of this review is to describe the management of obstetric hemorrhage from anesthetic point of view, encompassing the identification of patients at risk, resuscitative management, and perioperative management.

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Section: Specific Resuscitation Of Obstetric Hemorrhagementioning

confidence: 99%

Section: Specific Resuscitation Of Obstetric Hemorrhagementioning

confidence: 99%

The Role Anesthesiologist in Management of Obstetric Haemorrhage: A Literature Review

Shantikaratri,

Isngadi

2024

MACC

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“…Currently, in our own institutions the threshold for the point-of care diagnostic devices to apply fibrinogen is 12 mm (FIBTEM A 5), while an EXTEM Clotting time >75 may indicate the need for prothrombin complex concentrate [50].…”

Section: Transfusionmentioning

confidence: 99%

Coagulation management and transfusion in massive postpartum hemorrhage

Massoth

Wenk

Meybohm

et al. 2023

Current Opinion in Anaesthesiology

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Purpose of ReviewExcessive bleeding during and following childbirth remains one of the leading causes of maternal mortality.Recent findingsCurrent guidelines differ in definitions and recommendations on managing transfusion and hemostasis in massive postpartum hemorrhage (PPH). Insights gained from trauma-induced coagulopathy are not directly transferable to the obstetric population due to gestational alterations and a differing pathophysiology.SummaryFactor deficiency is uncommon at the beginning of most etiologies of PPH but will eventually develop from consumption and depletion in the absence of bleeding control. The sensitivity of point-of-care tests for fibrinolysis is too low and may delay treatment, therefore tranexamic acid should be started early at diagnosis even without signs for hyperfibrinolysis. Transfusion management may be initiated empirically, but is best to be guided by laboratory and viscoelastic assay results as soon as possible. Hypofibrinogenemia is well detected by point-of-care tests, thus substitution may be tailored to individual needs, while reliable thresholds for fresh frozen plasma (FFP) and specific components are yet to be defined. In case of factor deficiency, prothrombin complex concentrate or lyophilized plasma allow for a more rapid restoration of coagulation than FFP. If bleeding and hemostasis are under control, a timely anticoagulation may be necessary.

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