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Critical Obstetrical Hemorrhage

  • Shigetaka MatsunagaEmail author
  • Satoru Takeda
Chapter

Abstract

Currently, critical obstetrical hemorrhage is reported to be the number one cause of maternal deaths in Japan. The Japanese Clinical Practice Guide for Critical Obstetrical Hemorrhage was revised in 2017. According to these guidelines, the role of treatment strategies in tertiary medical facilities is important, but the role of the criteria used by clinics for determining the timing of transport is also important. Thus, the aim of these guidelines is to further reduce the maternal death rate in Japan. With this revision, the guideline newly emphasizes the measurement of fibrinogen level and the importance of supplementation. Fibrinogen is an essential protein for hemostasis. It is the first coagulation factor below the critical level for hemostasis. Therefore, treating hypofibrinogenemia at an early stage of coagulopathy due to massive obstetric hemorrhage is the most important strategy. Additionally, administration of sufficient coagulation factor from an early stage, particularly fibrinogen supplementation, is essential to prevent worsening of coagulopathy. The use of fibrinogen concentrate is discussed as an efficient way to supplement fibrinogen.

Keywords

Fibrinogen concentrate Obstetrical hemorrhage Disseminated intravascular coagulation Shock Coagulopathy 

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Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Center for Maternal, Fetal, and Neonatal Medicine, Saitama Medical CenterSaitama Medical UniversityKawagoeJapan
  2. 2.Department of Obstetrics and Gynecology, Faculty of MedicineJuntendo UniversityBunkyo-kuJapan

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