A Survey of Current Treatment Practices for Postpartum Hemorrhage by Practicing Obstetricians and Hematologists

DOI: 10.4236/ojog.2014.46044   PDF   HTML     5,645 Downloads   7,358 Views   Citations


Objective: To identify current treatment strategies for postpartum hemorrhage used by obstetricians (OB/GYNs) and hematologists (HEMs). Study Design: We conducted a survey of OB/GYNs (n = 220) and HEMs (n = 30) to describe the characteristics of current treatment strategies for postpartum hemorrhage. Surveys were administered via a structured questionnaire on a secure internet website from 5 - 12 October 2009. Results: The majority of OB/GYN and HEM respondents were practicing in a community hospital environment (77%). Of the OB/GYNs, the majority practiced at hospitals with over 2000 deliveries per year (77%). A majority (58%) of OB/GYNs were affiliated with hospitals that lacked a massive transfusion protocol to treat severe postpartum hemorrhage. Subsequent to uterine massage and additional oxytocin, the majority of OB/GYNs (73%), preferred the administration of Methergine? as the next level of intervention for postpartum hemorrhage. There was considerable variability in response to specific treatment strategies for several hypothetical case scenarios; however, the large majority of OB/GYNs favored obstetrical procedures over interventional radiology or administration of rFVIIa. A large majority (77%) of physicians who are familiar with rRVIIa as treatment for postpartum hemorrhage reported being very satisfied with the agent for this indication. Conclusions: An established, systematic treatment strategy among OB/GYNs emerged only in the case of mild postpartum hemorrhage.

Share and Cite:

Triche, E. , Wehrum, M. and Paidas, M. (2014) A Survey of Current Treatment Practices for Postpartum Hemorrhage by Practicing Obstetricians and Hematologists. Open Journal of Obstetrics and Gynecology, 4, 279-293. doi: 10.4236/ojog.2014.46044.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Cohen, W.R. (2006) Hemorrhagic Shock in Obstetrics. Journal of Perinatal Medicine, 34, 263-271. http://dx.doi.org/10.1515/JPM.2006.051
[2] Johns, B., Sigurbjornsdottir, K., Fogstad, H., Zupan, J., Mathai, M. and Tan-Torres Edejer, T. (2007) Estimated Global Resources Needed to Attain Universal Coverage of Maternal and Newborn Health Services. Bull World Health Organ, 85, 256-263. http://dx.doi.org/10.2471/BLT.06.032037
[3] Mathai, M., Gulmezoglu, A.M. and Hill, S. (2007) Saving Women’s Lives: Evidence-Based Recommendations for the Prevention of Postpartum Haemorrhage. Bull World Health Organ, 85, 322-323.
[4] Health Advisory (2004) Prevention of Maternal Deaths through Improved Management of Hemorrhage.www.health.state.ny.us/professionals/protocols_and_guidelines/maternal_hemorrhage/
[5] American Academy of Pediatrics and American College of Obstetricians and Gynecologists (2007) Guidelines for Perinatal Care. 6th Edition, American Academy of Pediatrics and the American College of Obstetricians and Gynecologists; Washington DC.
[6] Bouwmeester, F.W., Bolte, A.C. and van Geijn, H.P. (2005) Pharmacological and Surgical Therapy for Primary Postpartum Hemorrhage. Current Pharmaceutical Design, 11, 759-773.
[7] Haljamae, H. (1993) The Pathophysiology of Shock. Acta Anaesthesiologica Scandinavica, 98, 3-6. http://dx.doi.org/10.1111/j.1399-6576.1991.tb05064.x
[8] Velanovich, V. (1989) Crystalloid versus Colloid Fluid Resuscitation: A Meta-Analysis of Mortality. Surgery, 105, 65-71.
[9] Schwartz, S.I., Shires, G.T. and Spencer, F.C. (1999) Hemostasis, Surgical Bleeding, and Transfusion. In: Anonymous, Ed., Schwartz’s Principles of Surgery, 7th Edition, McGraw-Hill Professional, New York, 107-108.
[10] Matot, I., Einav, S., Goodman, S., Zeldin, A., Weissman, C. and Elchalal, U. (2004) A Survey of Physicians’ Attitudes toward Blood Transfusion in Patients Undergoing Cesarean Section. American Journal of Obstetic Gynecology, 190, 462-467. http://dx.doi.org/10.1016/j.ajog.2003.07.028
[11] Santoso, J.T., Saunders, B.A. and Grosshart, K. (2005) Massive Blood Loss and Transfusion in Obstetrics and Gynecology. Obstetrical & Gynecological Survey, 60, 827-837.
[12] Burtelow, M., Riley, E., Druzin, M., Fontaine, M., Viele, M. and Goodnough, L.T. (2007) How We Treat: Management of Life-Threatening Primary Postpartum Hemorrhage with a Standardized Massive Transfusion Protocol. Transfusion, 47, 1564-1572. http://dx.doi.org/10.1111/j.1537-2995.2007. 01404.x
[13] Bouma, L.S., Bolte, A.C. and van Geijn, H.P. (2008) Use of Recombinant Activated Factor VII in Massive Postpartum Haemorrhage. The European Journal of Obstetrics & Gynecology and Reproductive Biology, 137, 172-177. http://dx.doi.org/10.1016/j.ejogrb.2007.06.022
[14] Bouwmeester, F.W., Jonkhoff, A.R., Verheijen, R.H. and van Geijn, H.P. (2003) Successful Treatment of Life-Threatening Postpartum Hemorrhage with Recombinant Activated Factor VII. Obstetrics & Gynecology, 101, 1174-1176. http://dx.doi.org/10.1016/S0029-7844(03)00350-8
[15] Brice, A., Hilbert, U., Roger-Christoph, S., Fernandez, H., Dumenil, A.S., Descorps-Declere, A., Mercier, F. and Benhamou, D. (2004) Recombinant Activated Factor VII as a Life-Saving Therapy for Severe Postpartum Haemorrhage Unresponsive to Conservative Traditional Management. Annales Fran?aises d'Anesthésie et de Réanimation, 23, 10841088. http://dx.doi.org/10.1016/j.annfar.2004.09.005
[16] Haynes, J., Laffan, M. and Plaat, F. (2007) Use of Recombinant Activated Factor VII in Massive Obstetric Haemorrhage. International Journal of Obstetric Anesthesia, 16, 40-49.
[17] Sobieszczyk, S., Breborowicz, G.H., Platicanov, V., Tanchev, S. and Kessler, C.M. (2006) Recombinant Factor VIIa in the Management of Postpartum Bleeds: An Audit of Clinical Use. Acta Obstetricia et Gynecologica Scandinavica, 85, 1239-1247. http://dx.doi.org/10.1080/00016340600855839
[18] Hossain, N., Shamsi, T., Haider, S., Soomro, N., Khan, N.H., Memon, G.U., Farzana, T., Ansari, S., Triche, E.W., Kuczynski, E., et al. (2007) Use of Recombinant Activated Factor VII for Massive Postpartum Hemorrhage. Acta Obstetricia et Gynecologica Scandinavica, 86, 1200-1206.
[19] Phillips, L.E., McLintock, C., Pollock, W., Gatt, S., Popham, P., Jankelowitz, G., Ogle, R. and Cameron, P.A. (2009) Australian and New Zealand Haemostasis Registry: Recombinant Activated Factor VII in Obstetric Hemorrhage: Experiences from the Australian and New Zealand Haemostasis Registry. Anesthesia & Analgesia, 109, 1908-1915. http://dx.doi.org/10.1213/ANE.0b013e3181c039e6
[20] Perkins, J.G., Cap, A.P., Weiss, B.M., Reid, T.J. and Bolan, C.D. (2008) Massive Transfusion and Nonsurgical Hemostatic Agents. Critical Care Medicine, 36, S325-S339. http://dx.doi.org/10.1097/ CCM.0b013e31817e2ec5
[21] Malone, D.L., Hess, J.R. and Fingerhut, A. (2006) Massive Transfusion Practices around the Globe and a Suggestion for a Common Massive Transfusion Protocol. Journal of Trauma, 60, S91-S96. http://dx.doi.org/10.1097/01.ta.0000199549.80731.e6
[22] Cameron, C.A., Roberts, C.L., Bell, J. and Fischer, W. (2007) Getting an Evidence-Based Post-Partum Haemorrhage Policy into Practice. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47, 169-175. http://dx.doi.org/10.1111/j.1479-828X.2007.00713.x
[23] Rajan, P.V. and Wing, D.A. (2010) Postpartum Hemorrhage: Evidence-Based Medical Interventions for Prevention and Treatment. Clinical Obstetrics & Gynecology, 53, 165-181. http://dx.doi.org/10.1097/ GRF.0b013e3181ce0965
[24] Heilmann, L., Wild, C., Hojnacki, B. and Pollow, K. (2006) Successful Treatment of Life-Threatening Bleeding after Cesarean Section with Recombinant Activated Factor VII. Clinical and Applied Thrombosis/Hemostasis, 12, 227-229. http://dx.doi.org/10.1177/107602960601200213
[25] Levy, J.H., Dutton, R.P., Hemphill III, J.C., Shander, A., Cooper, D., Paidas, M.J., Kessler, C.M., Holcomb, J.B. and Lawson, J.H. (2010) Hemostasis Summit Participants: Multidisciplinary Approach to the Challenge of Hemostasis. Anesthesia & Analgesia, 110, 354-364.
[26] Fuller, A.J. and Bucklin, B. (2007) Blood Component Therapy in Obstetrics. Obstetrics and Gynecology Clinics of North America, 34, 443-458. http://dx.doi.org/10.1016/j.ogc.2007.06.003
[27] Prendiville, W.J., Harding, J.E., Elbourne, D.R. and Stirrat, G.M. (1988) The Bristol Third Stage Trial: Active versus Physiological Management of Third Stage of Labour. British Medical Journal, 297, 1295-1300. http://dx.doi.org/10.1136/bmj.297.6659.1295
[28] American College of Obstetricians and Gynecologists (2006) ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists, Number 76, October 2006: Postpartum Hemorrhage. Obstetrics and Gynecology, 108, 1039-1047.
[29] Pacheco, L.D., Saade, G.R., Gei, A.F. and Hankins, G.D. (2011) Cutting-Edge Advances in the Medical Management of Obstetrical Hemorrhage. American Journal of Obstetrics & Gynecology, 205, 526-532. http://dx.doi.org/10.1016/j.ajog.2011.06.009
[30] Shakur, H., Elbourne, D., Gülmezoglu, M., Alfirevic, Z., Ronsmans, C., Allen, E. and Roberts, I. (2010) The WOMAN Trial (World Maternal Antifibrinolytic Trial): Tranexamic Acid for the Treatment of Postpartum Haemorrhage: An International Randomised, Double Blind Placebo Controlled Trial. Trials, 11, 40. http://dx.doi.org/10.1186/1745-6215-11-40
[31] Wikkelsoe, A.J., Afshari, A., Stensballe, J., Langhoff-Roos, J., Albrechtsen, C., Ekelund, K., Hanke, G., Sharif, H.F., Mitchell, A.U., Svare, J., et al. (2012) The FIB-PPH Trial: Fibrinogen Concentrate as Initial Treatment for Postpartum Haemorrhage: Study Protocol for a Randomised Controlled Trial. Trials, 13, 110. http://dx.doi.org/10.1186/1745-6215-13-110

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.