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Evaluation and management of postpartum hemorrhage: consensus from an international expert panel.

Publication ,  Journal Article
Abdul-Kadir, R; McLintock, C; Ducloy, A-S; El-Refaey, H; England, A; Federici, AB; Grotegut, CA; Halimeh, S; Herman, JH; Hofer, S; James, AH ...
Published in: Transfusion
July 2014

BACKGROUND: Postpartum hemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide, although the lack of a precise definition precludes accurate data of the absolute prevalence of PPH. STUDY DESIGN AND METHODS: An international expert panel in obstetrics, gynecology, hematology, transfusion, and anesthesiology undertook a comprehensive review of the literature. At a meeting in November 2011, the panel agreed on a definition of severe PPH that would identify those women who were at a high risk of adverse clinical outcomes. RESULTS: The panel agreed on the following definition for severe persistent (ongoing) PPH: "Active bleeding >1000 mL within the 24 hours following birth that continues despite the use of initial measures including first-line uterotonic agents and uterine massage." A treatment algorithm for severe persistent PPH was subsequently developed. Initial evaluations include measurement of blood loss and clinical assessments of PPH severity. Coagulation screens should be performed as soon as persistent (ongoing) PPH is diagnosed, to guide subsequent therapy. If initial measures fail to stop bleeding and uterine atony persists, second- and third-line (if required) interventions should be instated. These include mechanical or surgical maneuvers, i.e., intrauterine balloon tamponade or hemostatic brace sutures with hysterectomy as the final surgical option for uncontrollable PPH. Pharmacologic options include hemostatic agents (tranexamic acid), with timely transfusion of blood and plasma products playing an important role in persistent and severe PPH. CONCLUSION: Early, aggressive, and coordinated intervention by health care professionals is critical in minimizing blood loss to ensure optimal clinical outcomes in management of women with severe, persistent PPH.

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Published In

Transfusion

DOI

EISSN

1537-2995

Publication Date

July 2014

Volume

54

Issue

7

Start / End Page

1756 / 1768

Location

United States

Related Subject Headings

  • Risk Factors
  • Professional Practice
  • Pregnancy
  • Practice Guidelines as Topic
  • Postpartum Hemorrhage
  • Labor, Obstetric
  • Humans
  • Hemostatics
  • Female
  • Expert Testimony
 

Citation

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ICMJE
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Abdul-Kadir, R., McLintock, C., Ducloy, A.-S., El-Refaey, H., England, A., Federici, A. B., … Winikoff, R. (2014). Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion, 54(7), 1756–1768. https://doi.org/10.1111/trf.12550
Abdul-Kadir, Rezan, Claire McLintock, Anne-Sophie Ducloy, Hazem El-Refaey, Adrian England, Augusto B. Federici, Chad A. Grotegut, et al. “Evaluation and management of postpartum hemorrhage: consensus from an international expert panel.Transfusion 54, no. 7 (July 2014): 1756–68. https://doi.org/10.1111/trf.12550.
Abdul-Kadir R, McLintock C, Ducloy A-S, El-Refaey H, England A, Federici AB, et al. Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion. 2014 Jul;54(7):1756–68.
Abdul-Kadir, Rezan, et al. “Evaluation and management of postpartum hemorrhage: consensus from an international expert panel.Transfusion, vol. 54, no. 7, July 2014, pp. 1756–68. Pubmed, doi:10.1111/trf.12550.
Abdul-Kadir R, McLintock C, Ducloy A-S, El-Refaey H, England A, Federici AB, Grotegut CA, Halimeh S, Herman JH, Hofer S, James AH, Kouides PA, Paidas MJ, Peyvandi F, Winikoff R. Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion. 2014 Jul;54(7):1756–1768.
Journal cover image

Published In

Transfusion

DOI

EISSN

1537-2995

Publication Date

July 2014

Volume

54

Issue

7

Start / End Page

1756 / 1768

Location

United States

Related Subject Headings

  • Risk Factors
  • Professional Practice
  • Pregnancy
  • Practice Guidelines as Topic
  • Postpartum Hemorrhage
  • Labor, Obstetric
  • Humans
  • Hemostatics
  • Female
  • Expert Testimony