Pharmacological Management of Postpartum Haemorrhage
https://doi.org/10.21292/2078-5658-2022-19-6-97-105
Abstract
Despite improvements in healthcare technologies, massive postpartum haemorrhage is still the leading cause of maternal morbidity and mortality worldwide. Delayed and poor-quality obstetric care can result in irreversible consequences. Well-timed assessment of blood loss, effective management of the peripartum period, and participation of multidisciplinary teams are essential to provide a specialized care. This review presents the evidence-based management of patients with the development of obstetric haemorrhage. The article presents existing contradictions in the methods of diagnosis and treatment as well as new advances in this field of medicine which require continuation of research in this direction.
About the Authors
A. V. Rostovtsev
St. Petersburg State Pediatric Medical University; Maternity Hospital no. 13
Russian Federation
Russian Federation
Andrey V. Rostovtsev - Post-Graduate Student of Anesthesiology- Intensive Care and Emergency Pediatrics Department within Professional Development Unit
2, Litovskaya St., St. Petersburg, 194100
Phone: + 7 (812) 591-79-19
Yu. S. Aleksandrovich
St. Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Yury S. Aleksandrovich - Doctor of Medical Sciences, Professor,
Head of Department of Anesthesiology, Intensive Care and Emergency Pediatrics, Faculty of Postgraduate Training and Additional Professional Education, Honored Scientist of the Russian Federation
2, Litovskaya St., St. Petersburg, 194100
Phone: + 7 (812) 591-79-19
O. V. Ryazanova
D. O. Ott Research Institute of Obstetrics, Gynecology and Reproductology
Russian Federation
Russian Federation
Oksana V. Ryazanova - D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Candidate of Medical Sciences, Head of Department of Obstetrics, Gynecology and Reproductology
3, Mendeleevskaya Line, St. Petersburg, 199034
T. I. Akimenko
St. Petersburg State Pediatric Medical University; City Pokrov Hospital
Russian Federation
Russian Federation
Tatiana I. Akimenko - Candidate of Medical Sciences, Associate Professor of Anesthesiology, Intensive Care and Emergency Pediatrics Department within Post-Graduate and Continuing Professional Development Faculty
2, Litovskaya St., St. Petersburg, 194100
Phone: + 7 (812) 591-79-19
K. V. Pshenisnov
St. Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Konstantin V. Pshenisnov - Doctor of Medical Sciences, Associate Professor of Anesthesiology, Intensive Care and Emergency Pediatrics Department within Post-Graduate and Continuing Professional Development Faculty
2, Litovskaya St., St. Petersburg, 194100
Phone: + 7 (812) 591-79-19
References
1. Aleksandrovich Yu.S., Rostovtsev A.V., Kononova E.S. et al. Efficacy of low doses of terlipressin to prevent intra-operative blood loss in obstetrics. Messenger of Anesthesiology and Resuscitation, 2020, vol. 17, no. 4, pp. 78-84. (In Russ.) doi: 10.21292/2078-5658-2020-17-4-78-84.
2. Dobrokhotova Yu.E., Dzhakhidze L.S. Tranexamic acid to prevent early postpartum hemorrhages. Russian Journal of Woman and Child Health, 2019, no. 1 (2), pp. 34-38. (In Russ.)
3. Korolev A.Yu., Fedorova T.A. Pyregov A.V. et al. Transfusion management of abdominal delivery in pregnant women at high risk of bleeding with hemostasis control. Meditsinsky Soviet, 2020, no. 13, pp. 29-38. (In Russ.) doi: 10.21518/2079-701X-2020-13-29-38.
4. Kulikov A.V., Shifman E.M. Poslerodovoye krovotecheniye. Аnesteziya, intensivnaya terapiya i reanimatsiya v akusherstve i ginekologii. Klinicheskie rekomendatsii. Protokoly lecheniya. [Postpartum hemorrhage. Anesthesia and intensive care in obstetrics and gynecology. Clinical recommendations. Treatment protocols]. 2021, pp. 548-628.
5. Raspopin Yu.S., Shifman E.M., Belinina A.A. et al. Efficiency and safety of terlipressin application during caesarian section in pregnant women with a high risk of bleeding: a multicenter comprehensive cohort study of Terli-Bleed. Part II. Voprosy Ginekologii, Akusherstva i Perinatologii, 2021, vol. 20, no. 2, pp. 26-32. (In Russ.) doi: 10.20953/1726-1678-2021-6-20-28.
6. Ronenson A.M., Shifman E.M., Kulikov A.V. Discussion issues of infusion therapy during postpartum hemorrhage. Problemy Reproduktsii, 2021, no. 5 (27), pp. 136-141. (In Russ.)
7. Fedorova T.A., Shmakov R.G., Rogachevskiy O.V. et al. Patient’s blood management in obstetric practice with placenta accrete. Meditsinsky Soviet, 2019, no. 7, pp. 134–141. https://doi.org/10.21518/2079-701X-2019-7-134-141.
8. Aksoy H., Aksoy Ü., Yücel B. et al. Blood loss in elective cesarean section: is there a difference related to the type of anesthesia? A randomizedprospective study. J. Turk. Ger. Gynecol. Assoc., 2015, no. 16 (3), pp. 158-163.doi: 10.5152/jtgga.2015.15034.
9. American College of Obstetricians and Gynecologists. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists Number 76, October 2006: Postpartum hemorrhage. Obstet Gynecol., 2006, no. 108, pp. 1039-1047. doi: 10.1097/00006250-200610000-00046.
10. Anger H.A. Postpartum infection, pain and experiences with care among women treated for postpartum hemorrhage in three African countries: A cohort study of women managed with and without condom-catheter uterine balloon tamponade. PLoS One, 2021. doi: 10.1371/journal.pone.0245988.
11. Brace V., Kernaghan D., Penney G. Leaning from adverse clinical outcomes: major obstetric haemorrhage in Scotland, 2003-2005. BJOG, 2007, no. 114, pp. 1388-1396. doi: 10.1111/j.1471-0528.2007.01533.x.
12. Carvajal J.A., Ramos I., Kusanovic J.P. et al. Damagecontrol resuscitation in obstetrics. J. Matern. Fetal. Neonatal. Med., 2022, no. 35, pp. 785-798.doi: 10.1080/14767058.2020.1730800.
13. Clark S.L., Hankins G.D. Preventing maternal death: 10 clinical diamonds. Obstet Gynecol., 2012, vol. 119, 2, pt. 1, pp. 360-364. doi:10.1097/AOG.0b013e3182411907.
14. Clunies-Ross N., Roston T.M., Taylor J. et al. The effect of carbetocin dose on transmural dispersion of myocardial repolarization in healthy parturients scheduled for elective cesarean delivery under spinal anesthesia: a prospective, randomized clinical trial. Anesth. Analg., 2021, vol. 132, no. 2, pp. 485-492. doi:10.1213/ANE.0000000000004712.
15. Cotter A., Ness A., Tolosa J. Prophylactic oxytocin in the third stage of labour. Cochrane Database Syst Rev., 2001, no. 4, CD001808. doi: 10.1002/14651858.CD001808.pub3.
16. Disease and injury borovac-pinheiro incidence and prevalence collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: A systematic analysis for the global burden of disease study 2015. Lancet, 2016, vol. 38. doi:10.1016/S0140-6736(16)31678-6.
17. Driessen M., Bouvier-Colle M.H., Dupont C. et al. Postpartum hemorrhage resulting from uterine atony after vaginal delivery: Factors associated with severity. Obstet Gynecol., 2011, vol. 117, pp. 21-31. doi: 10.1097/AOG.0b013e318202c845.
18. Ducloy-Bouthors A.S., Duhamel A., Kipnis E. et al. Postpartum haemorrhage related early increase in D-dimers is inhibited by tranexamic acid: haemostasis parameters of a randomized controlled open labelled trial. Br. J. Anaesth., 2016, vol. 116, pp. 641-648. doi: 10.1093/bja/aew021.
19. Ducloy-Bouthors A.S., Jude B., Duhamel A. et al. High-dose tranexamic acid reduces blood loss in post-partum haemorrhage. Crit. Care, 2011, no. 15, pp. 117. doi: 10.1186/cc10143.
20. Escobar M.F., Nassar A.H., Theron G. et al. FIGO recommendations on the management of postpartum hemorrhage 2022. Int. J. Gynecol. Obstet., 2022, no. 157, suppl. 1, pp. 3-50. doi: 10.1002/ijgo.14116.
21. Evensen A., Anderson J.M., Fontaine P. Postpartum hemorrhage: prevention and treatment. Am. Fam. Physician., 2017, vol. 95, pp. 442–449.
22. Fuchther C., Ortiz E.I., Escobar M.F. et al. Hemorragiapostparto: endondeestamos y haciadondevamos. federaciónlatinoamericna de sociedades de ginecologia y obstetricia. Epub. Accessed Aug 11, 2021. https://www.flasog.org/static/libros/HemorragiaPostparto17OCTUBRE.pd fdoi: 10.1002/ijgo.14116.
23. Gillissen A., van den Akker T., Caram-Deelder C. et al. Association between fluid management and dilutional coagulopathy in severe postpartum haemorrhage: a nationwide retrospective cohort study. BMC Pregnancy Childbirth, 2018, no. 18, pp. 398. doi: 10.1186/s12884-018-2021-9.
24. Glaze S., Ekwalanga P., Roberts G. et al. Peripartum hysterectomy 1999-2006. Obstetrics and Gynecology, 2008, no. 111, pp. 732-738. doi: 10.1097/AOG.0b013e31816569f2.
25. Haiyan S., Lei X., Yu Li et al. Effectiveness and safety of carboxytocin versus oxytocin in preventing postpartum hemorrhage: A systematic review and meta-analysis. J. Obstet. Gynaecol. Res., 2022, pp. 889-901. doi: 10.1111/jog.15174.
26. Imudia A.N., Awonuga A.O., Dbouk T. et al. 2009. Incidence, trends, risk factors, indications for and complications associated with caesarean hysterectomy: a 17-year experience from a single institution. Archives of Gynecology and Obstetrics, vol. 280, pp. 619-623. doi: 10.1007/s00404-009-0984-5.
27. Kato S., Tanabe A., Kanki K. et al. Local injection of vasopressin reduces the blood loss during cesarean section in placenta previa. J. Obstet. Gynaecol. Res., 2014, vol. 40, pp. 1249-1256. doi: 10.1111/jog.12356.
28. Ker K., Edwards P., Perel P. et al. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative metaanalysis. BMJ, 2012, no. 344, pp. e3054. doi: 10.1136/bmj.e3054.
29. Kozek-Langenecker S.A., Afshari A., Albaladejo P. et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur. J. Anaesthesiol., 2013, no. 30, pp. 270-382. doi: 10.1097/EJA.0b013e32835f4d5b.
30. Lecker I., Wang D.S., Whissell P.D. et al. Tranexamic acid-associated seizures: causes and treatment. Ann. Neurol., 2016, no. 79, pp. 18-26. doi: 10.1002/ana.24558.
31. Leduc D., Senikas V., Lalonde A.B. No 235-active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. J. Obstet. Gynaecol. Can., 2018, no. 40, pp. e841–e855.doi: 10.1016/j.jogc.2018.09.024.
32. Malm M., Madsen I., Kjellström J. Development and stability of a heat-stable formulation of carbetocin for the prevention of postpartum haemorrhage for use in low and middleincome countries. J. Pept. Sci., 2018, vol. 24, no. 6, pp. e3082.doi: 10.1002/psc.3082.
33. McDonagh F., Carvalho J.C.A., Abdulla S. et al. Carbetocin vs. oxytocin at elective caesarean delivery: a double-blind, randomised, controlled, non-inferiority trial of low- and high-dose regimens. Anaesthesia, 2022, Mar 28. doi: 10.1111/anae.15714.
34. Munn M.B., Owen J., Vincent R. et al. Comparison of two oxytocic regimens to prevent uterine atony at cesarean delivery; a randomized controlled trial. Obstet Gynecol., 2001, vol. 98, pp. 386-390. doi: 10.1016/s0029-7844(01)01479-x.
35. Nassar A.H., Theron G., Barnea E.R. et al. FIGO recommendations on the management of postpartum hemorrhage 2022. Int. J. Gynecol. Obstet., 2022, vol. 157, suppl. 1, pp. 3-50.doi: 10.1002/ijgo.14116.
36. Norfolk D. Handbook of Transfusion Medicine, United Kingdom Blood Services, 5th edition. UK. The stationary Office. 2015, pp. 186.
37. Ordóñez C.A., Nieto A.J., Carvajal J.A. et al Damage control surgery for the management of major obstetric hemorrhage: experience from the Fundación Valle del Lili, Cali, Colombia. Panam. J. Trauma Crit. Care Emerg. Surg., 2017, no. 6, pp. 1-7. doi: 10.1080/14767058.2020.1730800.
38. Pacheco L.D., Lozada M.J., Saade G.R. et al. Damage-control surgery for obstetric hemorrhage. Obstet. Gynecol., 2018, no. 132, pp. 423-427.doi: 10.1097/AOG.0000000000002743.
39. Prudovsky I., Carter D., Kacer D. et al. Tranexamic acid suppresses the release of mitochondrial DNA, protects the endothelial monolayer and enhances oxidative phosphorylation. J. Cell. Physiol., 2019, no. 234, pp. 19121-19129. doi: 10.1002/jcp.28603.
40. Schlembach D., Helmer H., Henrich W. et al. Peripartumhaemorrhage, diagnosis and therapy. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry No. 015/063, March 2016). Geburtshilfe Frauenheilkd, 2018, no. 78, pp. 382-399. doi: 10.1055/a-0582-0122.
41. Seifert S.M., Lumbreras-Marquez M.I., Goobie S.M. et al. Tranexamic acid administered during cesarean delivery in high-risk patients: maternal pharmacokinetics, pharmacodynamics, and coagulation status. Am. J. Obstet. Gynecol., 2022, June 6, S0002-9378(22)00441-0. doi: 10.1016/j.ajog.2022.06.001.
42. Sentilhes L., Sénat M.V., Le Lous M. et al Tranexamic acid for the prevention of blood loss after cesarean delivery. N. Engl. J. Med., 2021, no. 384, pp. 1623-1634. doi: 10.1056/NEJMoa2028788.
43. Shander A., Javidroozi M., Sentilhes L. Tranexamic acid and obstetric hemorrhage: give empirically or selectively? Int. J. Obstetric Anesth., 2021, no. 48, pp. 1. doi: org/10.1016/j.ijoa.2021.103206
44. Solomon C., Collis R.E., Collins P.W. Haemostatic monitoring during postpartum haemorrhage and implications for management. Br. J. Anaesth., 2012, no. 109, pp. 851-863. doi: 10.1093/bja/aes361.
45. Spahn D.R., Bouillon B., Cerny V. et al. The European guideline on management of major bleeding and coagulopathy following trauma. Crit. Care, 2019, no. 23, pp. 98. doi: 10.1186/s13054-019-2347-3.
46. Tan Y.Q., Liu S.J., Cao S.Y. et al. Comparison of the effectiveness and safety of carbetocin and oxytocin in preventing postpartum hemorrhage after vaginal delivery: a meta-analysis. Chin. J. Evid. Based Med., 2018, no. 10, pp. 1093-1100. doi: 10.1097/MD.0000000000017911.
47. Wang H., Chen M.B., Zheng X.W. et al. Effectiveness and safety of hypotensive resuscitation in traumatic hemorrhagic shock: a protocol for meta-analysis. Medicine., 2019, no. 98, pp. e18145. doi: 10.1097/MD.0000000000018145.
48. WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet, 2017, no. 389, pp. 2105-2116. doi: 10.1016/S0140-6736(17)30638-4.
49. World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Epub. Accessed August 11, 2021. https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548502/en/
50. Zwinkels R.L.J., Endeman H., Hoeks S.E. et al. The clinical effect of hemostatic resuscitation in traumatic hemorrhage; a before-after study. J. Crit. Care, 2020, no. 56, pp. 288-293. doi: 10.1016/j.jcrc.2019.11.013.
Review
For citations:
Rostovtsev A.V., Aleksandrovich Yu.S., Ryazanova O.V., Akimenko T.I., Pshenisnov K.V. Pharmacological Management of Postpartum Haemorrhage. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2022;19(6):97-105. (In Russ.) https://doi.org/10.21292/2078-5658-2022-19-6-97-105
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