Component Therapy in Obstetric Hemorrhage
Postpartum hemorrhage (PPH) remains one of the leading causes of maternal mortality worldwide. Epidemiologic studies have shown a worldwide increase in PPH, extending to developed countries including the United States (US). Although the overall prevalence is low, the rate of PPH in the US has increased from 1.5% in 1999 to 4.1% in 2009 . Numerous national and international societies have invested a great deal of effort in designing Patient Blood Management (PBM) guidelines in an effort to reduce the overall mortality rate associated with PPH. To date, there is no definitive consensus between the various societies’ PBM recommendations. This chapter will highlight a case of life-threatening PPH, detailing blood component therapy in the setting of massive obstetric bleeding. The discussion will include antepartum risk factors for PPH, severity of bleeding assessment, massive transfusion protocols (MTP), lab-directed product replacement, and the use of antifibrinolytic agents. This case and its accompanying information are intended to support the development of an institutional protocol to aggressively manage PPH to reduce the likelihood of hemorrhage-related morbidity and mortality.
KeywordsABO blood group Fibrinogen Cryoprecipitate Plasma Platelet Tranexamic acid Massive transfusion protocol Thromboelastometry (TEM)
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