Recombinant factor VIIa: use in fatal post partum hemorrhage — Indian experience case series and review of literature

Abstract

Postpartum hemorrhage is leading cause of maternal mortality and still remains a challenging condition to treat and hysterectomy may be required to control the bleeding once medical interventions fail. These strategies are not always successful and a direct approach in activating the coagulation system can be more effective and life saving. We describe here the mechanism of action of rFVIIa, review of literature and its use in 10 cases with different causes for PPH with good response.

Recombinant activated factor VII as a promising adjuvant therapy for postpartum hemorrhage in the practice of obstetric anesthesia: Experience from a university hospital in Taiwan

“…There were 5446 parturients, and 40 labors complicated with PPH during 2006–2009. In this case series we defined severe PPH as blood loss >150 mL/min (>50% of blood volume within 20 min), or sudden blood loss exceeding 1500–2000 mL 7 . Eight patients received rFVIIa (NovoSeven, 1.2 mg/vial; Novo Nordisk, Bagsvaerd, Denmark) as an adjuvant therapy for severe PPH refractory to the conventional treatments.…”

“…An investigation from Pakistan remarked that patients who received rFVIIa had lower maternal mortality and a lower number of packed red blood cell transfusions than those who did not receive the drug 12 . Another study also suggested the effectiveness of rFVIIa in PPH among 10 Indian women 7 . Since there is no published data regarding the Chinese population, we report our experience with a case series of eight patients receiving rFVIIa in PPH refractory to the conventional therapy in a Taiwanese hospital.…”

“…Massive postpartum hemorrhage (PPH) continues to be one of the world's leading causes of maternal morbidity and mortality 19 . It is defined as blood loss of more than 150 mL/min (more than 50% of blood volume within 20 min), or sudden blood loss exceeding 1500–2000 mL 7 . The conventional treatment usually starts with uterotonic agents, component therapy and fluid resuscitation.…”

Transfusion practices in obstetrics and gynaecology in a tertiary care center

“…The recombinant factor VIIa is advocated only after failure of other conventional therapies. Singi et al 13 have recommended recombinant factor VII a, 20-80 l g/kg in severe cases of postpartum hemorrhage. The purpose of a RCC transfusion is to restore oxygen carrying capacity in order to maintain adequacy of tissue oxygenation.…”

Blood Transfusion Practice in Obstetric and Gynecology: Impact of Educational Programs to Create Awareness for Judicious Use of Blood Components

“…The recombinant factor VIIa is advocated only after failure of other conventional therapies. Singi et al [12] have recommended recombinant factor VIIa, 20-80 lg/kg in severe cases of post partum hemorrhage.…”