Standardized Management Protocol in Severe Postpartum Hemorrhage: A Single-Center Study

Author:

Colucci Giuseppe12ORCID,Helsing Karin1,Biasiutti Franziska Demarmels1,Raio Luigi3,Schmid Pirmin1,Tsakiris Dimitrios A.4,Eberle Balthasar5,Surbek Daniel3,Lämmle Bernhard16,Alberio Lorenzo17

Affiliation:

1. Department of Hematology and Central Hematology Laboratory, University Hospital and University of Bern, Bern, Switzerland

2. Service of Hematology, Clinica Luganese Moncucco, Lugano, Switzerland

3. Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern, Switzerland

4. Department of Hematology, University Hospital Basel, Basel, Switzerland

5. Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital and University of Bern, Bern, Switzerland

6. Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany

7. Service et laboratoire central d’hématologie, CHUV, University Hospital of Lausanne, Lausanne, Switzerland

Abstract

Severe postpartum hemorrhage (sPPH) is an obstetric emergency that needs prompt and effective therapy to reduce the risk of complications. In this study, women who developed sPPH (study cohort, n = 27) were treated according to a standardized management protocol prescribing sequential administration of uterotonic drugs, crystalloids, tranexamic acid, labile blood products, low-dose fibrinogen, and recombinant activated factor VII (rFVIIa). This group was compared to patients treated with different strategies during 2 preceding periods: an in-house guideline regulating the administration of rFVIIa (historical cohort 1, n = 20) and no specific guideline (historical cohort 2, n = 27). The management protocol was used over 33 months. The study cohort had a lower estimated blood loss ( P = .004) and required less red blood cell concentrates ( P = .007), fresh frozen plasma units ( P = .004), and platelet concentrates ( P = .020) compared to historical cohort 1 and historical cohort 2, respectively. The necessity of emergency postpartum hysterectomy was lower in the study group ( P = .012). In conclusion, in patients with sPPH treated with this standardized management protocol, we observed a decreased requirement of labile blood products and lower need to proceed to emergency postpartum hysterectomy.

Funder

CSL Behring

Publisher

SAGE Publications

Subject

Hematology,General Medicine

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