Recent advances in the management of major obstetric haemorrhage

http://www.bjmp.org/content/recent-advances-management-major-obstetric-haemorrhage

Recent advances in the management of major obstetric haemorrhage

Rajashree Chavan and M Y Latoo

Cite this article as: BJMP 2013;6(1):a604 Download PDF

Introduction

Major Obstetric haemorrhage (MOH) remains one of the leading causes of maternal mortality & morbidity worldwide. In the 2003-2005 report of the UK Confidential Enquiries into Maternal Deaths, haemorrhage was the third highest direct cause of maternal death (6.6 deaths/million maternities) with the rate similar to the previous triennium ^{1, 2}. Postpartum haemorrhage (PPH) accounts for the majority of these deaths. This triennium, 2006-2008, unlike in previous reports there has been a change in the rankings of direct deaths by cause. Deaths from haemorrhage have dropped, to sixth place, following genital tract sepsis, preeclampsia, thromboembolism, amniotic fluid embolism and early pregnancy deaths ³. A well-defined multidisciplinary approach that aims to act quickly has probably been the key to successful management of MOH. In the developing world, several countries have maternal mortality rates in excess of 1000 women per 100,000 live births, and WHO statistics suggests that 25 % of maternal deaths are due to PPH, accounting for more than 100,000 maternal deaths per year ⁴.The blood loss may be notoriously difficult to assess in obstetric bleeds ^{5, 6}. Bleeding may sometimes be concealed & presence of amniotic fluid makes accurate estimation challenging.

Definition

MOH is variably defined as blood loss from uterus or genital tract >1500 mls or a decrease in haemoglobin of >4 gm/dl or acute loss requiring transfusion of >4 units of blood. Blood loss may be:

1. Antepartum: Haemorrhage after 24th week gestation & before delivery; for example: placenta praevia, placental abruption, bleeding from vaginal or cervical lesions.

2. Postpartum: Haemorrhage after delivery

· Primary PPH: Within 24 hours of delivery, which is >500 mls following vaginal delivery & > 1000mls following a caesarean section ⁷.

· Secondary PPH: 24 hours to 6 weeks post-delivery; for example: Uterine atony, retained products of conception, genital tract trauma, uterine inversion, puerperal sepsis, uterine pathology such as fibroids ⁸.

PPH can be minor (500-1000 mls) or major (> 1000 mls). Major PPH could be divided to moderate (1000-2000 mls) or severe (>2000 mls).

12 3 4 Следующая ⇒