A Survey of Current Treatment Practices for Postpartum Hemorrhage by Practicing Obstetricians and Hematologists
Affiliation(s)
Department of Epidemiology, Brown University School of Public Health, Providence, USA. Department of Obstetrics & Gynecology, Womack Army Medical Center, Fort Bragg, NC, USA. Yale Women and Children’s Center for Blood Disorders, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, Yale University, New Haven, USA.
Department of Epidemiology, Brown University School of Public Health, Providence, USA. Department of Obstetrics & Gynecology, Womack Army Medical Center, Fort Bragg, NC, USA. Yale Women and Children’s Center for Blood Disorders, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, Yale University, New Haven, USA.
ABSTRACT
Objective: To identify current treatment strategies for postpartum hemorrhage used by obstetricians (OB/GYNs) and hematologists (HEMs). Study Design: We conducted a survey of OB/GYNs (n = 220) and HEMs (n = 30) to describe the characteristics of current treatment strategies for postpartum hemorrhage. Surveys were administered via a structured questionnaire on a secure internet website from 5 - 12 October 2009. Results: The majority of OB/GYN and HEM respondents were practicing in a community hospital environment (77%). Of the OB/GYNs, the majority practiced at hospitals with over 2000 deliveries per year (77%). A majority (58%) of OB/GYNs were affiliated with hospitals that lacked a massive transfusion protocol to treat severe postpartum hemorrhage. Subsequent to uterine massage and additional oxytocin, the majority of OB/GYNs (73%), preferred the administration of Methergine? as the next level of intervention for postpartum hemorrhage. There was considerable variability in response to specific treatment strategies for several hypothetical case scenarios; however, the large majority of OB/GYNs favored obstetrical procedures over interventional radiology or administration of rFVIIa. A large majority (77%) of physicians who are familiar with rRVIIa as treatment for postpartum hemorrhage reported being very satisfied with the agent for this indication. Conclusions: An established, systematic treatment strategy among OB/GYNs emerged only in the case of mild postpartum hemorrhage.
Cite this paper
Triche, E. , Wehrum, M. and Paidas, M. (2014) A Survey of Current Treatment Practices for Postpartum Hemorrhage by Practicing Obstetricians and Hematologists. Open Journal of Obstetrics and Gynecology, 4, 279-293. doi: 10.4236/ojog.2014.46044.
Triche, E. , Wehrum, M. and Paidas, M. (2014) A Survey of Current Treatment Practices for Postpartum Hemorrhage by Practicing Obstetricians and Hematologists. Open Journal of Obstetrics and Gynecology, 4, 279-293. doi: 10.4236/ojog.2014.46044.
References
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http://dx.doi.org/10.2174/1381612053381882 [7] Haljamae, H. (1993) The Pathophysiology of Shock. Acta Anaesthesiologica Scandinavica, 98, 3-6. http://dx.doi.org/10.1111/j.1399-6576.1991.tb05064.x [8] Velanovich, V. (1989) Crystalloid versus Colloid Fluid Resuscitation: A Meta-Analysis of Mortality. Surgery, 105, 65-71. [9] Schwartz, S.I., Shires, G.T. and Spencer, F.C. (1999) Hemostasis, Surgical Bleeding, and Transfusion. In: Anonymous, Ed., Schwartz’s Principles of Surgery, 7th Edition, McGraw-Hill Professional, New York, 107-108. [10] Matot, I., Einav, S., Goodman, S., Zeldin, A., Weissman, C. and Elchalal, U. (2004) A Survey of Physicians’ Attitudes toward Blood Transfusion in Patients Undergoing Cesarean Section. American Journal of Obstetic Gynecology, 190, 462-467. http://dx.doi.org/10.1016/j.ajog.2003.07.028 [11] Santoso, J.T., Saunders, B.A. and Grosshart, K. (2005) Massive Blood Loss and Transfusion in Obstetrics and Gynecology. Obstetrical & Gynecological Survey, 60, 827-837.
http://dx.doi.org/10.1097/01.ogx.0000189154.98227.4b [12] Burtelow, M., Riley, E., Druzin, M., Fontaine, M., Viele, M. and Goodnough, L.T. (2007) How We Treat: Management of Life-Threatening Primary Postpartum Hemorrhage with a Standardized Massive Transfusion Protocol. Transfusion, 47, 1564-1572. http://dx.doi.org/10.1111/j.1537-2995.2007. 01404.x [13] Bouma, L.S., Bolte, A.C. and van Geijn, H.P. (2008) Use of Recombinant Activated Factor VII in Massive Postpartum Haemorrhage. The European Journal of Obstetrics & Gynecology and Reproductive Biology, 137, 172-177. http://dx.doi.org/10.1016/j.ejogrb.2007.06.022 [14] Bouwmeester, F.W., Jonkhoff, A.R., Verheijen, R.H. and van Geijn, H.P. (2003) Successful Treatment of Life-Threatening Postpartum Hemorrhage with Recombinant Activated Factor VII. Obstetrics & Gynecology, 101, 1174-1176. http://dx.doi.org/10.1016/S0029-7844(03)00350-8 [15] Brice, A., Hilbert, U., Roger-Christoph, S., Fernandez, H., Dumenil, A.S., Descorps-Declere, A., Mercier, F. and Benhamou, D. (2004) Recombinant Activated Factor VII as a Life-Saving Therapy for Severe Postpartum Haemorrhage Unresponsive to Conservative Traditional Management. Annales Fran?aises d'Anesthésie et de Réanimation, 23, 10841088. http://dx.doi.org/10.1016/j.annfar.2004.09.005 [16] Haynes, J., Laffan, M. and Plaat, F. (2007) Use of Recombinant Activated Factor VII in Massive Obstetric Haemorrhage. International Journal of Obstetric Anesthesia, 16, 40-49.
http://dx.doi.org/10.1016/j.ijoa.2006.07.005 [17] Sobieszczyk, S., Breborowicz, G.H., Platicanov, V., Tanchev, S. and Kessler, C.M. (2006) Recombinant Factor VIIa in the Management of Postpartum Bleeds: An Audit of Clinical Use. Acta Obstetricia et Gynecologica Scandinavica, 85, 1239-1247. http://dx.doi.org/10.1080/00016340600855839 [18] Hossain, N., Shamsi, T., Haider, S., Soomro, N., Khan, N.H., Memon, G.U., Farzana, T., Ansari, S., Triche, E.W., Kuczynski, E., et al. (2007) Use of Recombinant Activated Factor VII for Massive Postpartum Hemorrhage. Acta Obstetricia et Gynecologica Scandinavica, 86, 1200-1206.
http://dx.doi.org/10.1080/00016340701619324 [19] Phillips, L.E., McLintock, C., Pollock, W., Gatt, S., Popham, P., Jankelowitz, G., Ogle, R. and Cameron, P.A. (2009) Australian and New Zealand Haemostasis Registry: Recombinant Activated Factor VII in Obstetric Hemorrhage: Experiences from the Australian and New Zealand Haemostasis Registry. Anesthesia & Analgesia, 109, 1908-1915. http://dx.doi.org/10.1213/ANE.0b013e3181c039e6 [20] Perkins, J.G., Cap, A.P., Weiss, B.M., Reid, T.J. and Bolan, C.D. (2008) Massive Transfusion and Nonsurgical Hemostatic Agents. Critical Care Medicine, 36, S325-S339. http://dx.doi.org/10.1097/ CCM.0b013e31817e2ec5 [21] Malone, D.L., Hess, J.R. and Fingerhut, A. (2006) Massive Transfusion Practices around the Globe and a Suggestion for a Common Massive Transfusion Protocol. Journal of Trauma, 60, S91-S96. http://dx.doi.org/10.1097/01.ta.0000199549.80731.e6 [22] Cameron, C.A., Roberts, C.L., Bell, J. and Fischer, W. (2007) Getting an Evidence-Based Post-Partum Haemorrhage Policy into Practice. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47, 169-175. http://dx.doi.org/10.1111/j.1479-828X.2007.00713.x [23] Rajan, P.V. and Wing, D.A. (2010) Postpartum Hemorrhage: Evidence-Based Medical Interventions for Prevention and Treatment. Clinical Obstetrics & Gynecology, 53, 165-181. http://dx.doi.org/10.1097/ GRF.0b013e3181ce0965 [24] Heilmann, L., Wild, C., Hojnacki, B. and Pollow, K. (2006) Successful Treatment of Life-Threatening Bleeding after Cesarean Section with Recombinant Activated Factor VII. Clinical and Applied Thrombosis/Hemostasis, 12, 227-229. http://dx.doi.org/10.1177/107602960601200213 [25] Levy, J.H., Dutton, R.P., Hemphill III, J.C., Shander, A., Cooper, D., Paidas, M.J., Kessler, C.M., Holcomb, J.B. and Lawson, J.H. (2010) Hemostasis Summit Participants: Multidisciplinary Approach to the Challenge of Hemostasis. Anesthesia & Analgesia, 110, 354-364.
http://dx.doi.org/10.1213/ANE.0b013e3181c84ba5 [26] Fuller, A.J. and Bucklin, B. (2007) Blood Component Therapy in Obstetrics. Obstetrics and Gynecology Clinics of North America, 34, 443-458. http://dx.doi.org/10.1016/j.ogc.2007.06.003 [27] Prendiville, W.J., Harding, J.E., Elbourne, D.R. and Stirrat, G.M. (1988) The Bristol Third Stage Trial: Active versus Physiological Management of Third Stage of Labour. British Medical Journal, 297, 1295-1300. http://dx.doi.org/10.1136/bmj.297.6659.1295 [28] American College of Obstetricians and Gynecologists (2006) ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists, Number 76, October 2006: Postpartum Hemorrhage. Obstetrics and Gynecology, 108, 1039-1047. [29] Pacheco, L.D., Saade, G.R., Gei, A.F. and Hankins, G.D. (2011) Cutting-Edge Advances in the Medical Management of Obstetrical Hemorrhage. American Journal of Obstetrics & Gynecology, 205, 526-532. http://dx.doi.org/10.1016/j.ajog.2011.06.009 [30] Shakur, H., Elbourne, D., Gülmezoglu, M., Alfirevic, Z., Ronsmans, C., Allen, E. and Roberts, I. (2010) The WOMAN Trial (World Maternal Antifibrinolytic Trial): Tranexamic Acid for the Treatment of Postpartum Haemorrhage: An International Randomised, Double Blind Placebo Controlled Trial. Trials, 11, 40. http://dx.doi.org/10.1186/1745-6215-11-40 [31] Wikkelsoe, A.J., Afshari, A., Stensballe, J., Langhoff-Roos, J., Albrechtsen, C., Ekelund, K., Hanke, G., Sharif, H.F., Mitchell, A.U., Svare, J., et al. (2012) The FIB-PPH Trial: Fibrinogen Concentrate as Initial Treatment for Postpartum Haemorrhage: Study Protocol for a Randomised Controlled Trial. Trials, 13, 110. http://dx.doi.org/10.1186/1745-6215-13-110
[1] Cohen, W.R. (2006) Hemorrhagic Shock in Obstetrics. Journal of Perinatal Medicine, 34, 263-271. http://dx.doi.org/10.1515/JPM.2006.051 [2] Johns, B., Sigurbjornsdottir, K., Fogstad, H., Zupan, J., Mathai, M. and Tan-Torres Edejer, T. (2007) Estimated Global Resources Needed to Attain Universal Coverage of Maternal and Newborn Health Services. Bull World Health Organ, 85, 256-263. http://dx.doi.org/10.2471/BLT.06.032037 [3] Mathai, M., Gulmezoglu, A.M. and Hill, S. (2007) Saving Women’s Lives: Evidence-Based Recommendations for the Prevention of Postpartum Haemorrhage. Bull World Health Organ, 85, 322-323. [4] Health Advisory (2004) Prevention of Maternal Deaths through Improved Management of Hemorrhage.www.health.state.ny.us/professionals/protocols_and_guidelines/maternal_hemorrhage/ [5] American Academy of Pediatrics and American College of Obstetricians and Gynecologists (2007) Guidelines for Perinatal Care. 6th Edition, American Academy of Pediatrics and the American College of Obstetricians and Gynecologists; Washington DC. [6] Bouwmeester, F.W., Bolte, A.C. and van Geijn, H.P. (2005) Pharmacological and Surgical Therapy for Primary Postpartum Hemorrhage. Current Pharmaceutical Design, 11, 759-773.
http://dx.doi.org/10.2174/1381612053381882 [7] Haljamae, H. (1993) The Pathophysiology of Shock. Acta Anaesthesiologica Scandinavica, 98, 3-6. http://dx.doi.org/10.1111/j.1399-6576.1991.tb05064.x [8] Velanovich, V. (1989) Crystalloid versus Colloid Fluid Resuscitation: A Meta-Analysis of Mortality. Surgery, 105, 65-71. [9] Schwartz, S.I., Shires, G.T. and Spencer, F.C. (1999) Hemostasis, Surgical Bleeding, and Transfusion. In: Anonymous, Ed., Schwartz’s Principles of Surgery, 7th Edition, McGraw-Hill Professional, New York, 107-108. [10] Matot, I., Einav, S., Goodman, S., Zeldin, A., Weissman, C. and Elchalal, U. (2004) A Survey of Physicians’ Attitudes toward Blood Transfusion in Patients Undergoing Cesarean Section. American Journal of Obstetic Gynecology, 190, 462-467. http://dx.doi.org/10.1016/j.ajog.2003.07.028 [11] Santoso, J.T., Saunders, B.A. and Grosshart, K. (2005) Massive Blood Loss and Transfusion in Obstetrics and Gynecology. Obstetrical & Gynecological Survey, 60, 827-837.
http://dx.doi.org/10.1097/01.ogx.0000189154.98227.4b [12] Burtelow, M., Riley, E., Druzin, M., Fontaine, M., Viele, M. and Goodnough, L.T. (2007) How We Treat: Management of Life-Threatening Primary Postpartum Hemorrhage with a Standardized Massive Transfusion Protocol. Transfusion, 47, 1564-1572. http://dx.doi.org/10.1111/j.1537-2995.2007. 01404.x [13] Bouma, L.S., Bolte, A.C. and van Geijn, H.P. (2008) Use of Recombinant Activated Factor VII in Massive Postpartum Haemorrhage. The European Journal of Obstetrics & Gynecology and Reproductive Biology, 137, 172-177. http://dx.doi.org/10.1016/j.ejogrb.2007.06.022 [14] Bouwmeester, F.W., Jonkhoff, A.R., Verheijen, R.H. and van Geijn, H.P. (2003) Successful Treatment of Life-Threatening Postpartum Hemorrhage with Recombinant Activated Factor VII. Obstetrics & Gynecology, 101, 1174-1176. http://dx.doi.org/10.1016/S0029-7844(03)00350-8 [15] Brice, A., Hilbert, U., Roger-Christoph, S., Fernandez, H., Dumenil, A.S., Descorps-Declere, A., Mercier, F. and Benhamou, D. (2004) Recombinant Activated Factor VII as a Life-Saving Therapy for Severe Postpartum Haemorrhage Unresponsive to Conservative Traditional Management. Annales Fran?aises d'Anesthésie et de Réanimation, 23, 10841088. http://dx.doi.org/10.1016/j.annfar.2004.09.005 [16] Haynes, J., Laffan, M. and Plaat, F. (2007) Use of Recombinant Activated Factor VII in Massive Obstetric Haemorrhage. International Journal of Obstetric Anesthesia, 16, 40-49.
http://dx.doi.org/10.1016/j.ijoa.2006.07.005 [17] Sobieszczyk, S., Breborowicz, G.H., Platicanov, V., Tanchev, S. and Kessler, C.M. (2006) Recombinant Factor VIIa in the Management of Postpartum Bleeds: An Audit of Clinical Use. Acta Obstetricia et Gynecologica Scandinavica, 85, 1239-1247. http://dx.doi.org/10.1080/00016340600855839 [18] Hossain, N., Shamsi, T., Haider, S., Soomro, N., Khan, N.H., Memon, G.U., Farzana, T., Ansari, S., Triche, E.W., Kuczynski, E., et al. (2007) Use of Recombinant Activated Factor VII for Massive Postpartum Hemorrhage. Acta Obstetricia et Gynecologica Scandinavica, 86, 1200-1206.
http://dx.doi.org/10.1080/00016340701619324 [19] Phillips, L.E., McLintock, C., Pollock, W., Gatt, S., Popham, P., Jankelowitz, G., Ogle, R. and Cameron, P.A. (2009) Australian and New Zealand Haemostasis Registry: Recombinant Activated Factor VII in Obstetric Hemorrhage: Experiences from the Australian and New Zealand Haemostasis Registry. Anesthesia & Analgesia, 109, 1908-1915. http://dx.doi.org/10.1213/ANE.0b013e3181c039e6 [20] Perkins, J.G., Cap, A.P., Weiss, B.M., Reid, T.J. and Bolan, C.D. (2008) Massive Transfusion and Nonsurgical Hemostatic Agents. Critical Care Medicine, 36, S325-S339. http://dx.doi.org/10.1097/ CCM.0b013e31817e2ec5 [21] Malone, D.L., Hess, J.R. and Fingerhut, A. (2006) Massive Transfusion Practices around the Globe and a Suggestion for a Common Massive Transfusion Protocol. Journal of Trauma, 60, S91-S96. http://dx.doi.org/10.1097/01.ta.0000199549.80731.e6 [22] Cameron, C.A., Roberts, C.L., Bell, J. and Fischer, W. (2007) Getting an Evidence-Based Post-Partum Haemorrhage Policy into Practice. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47, 169-175. http://dx.doi.org/10.1111/j.1479-828X.2007.00713.x [23] Rajan, P.V. and Wing, D.A. (2010) Postpartum Hemorrhage: Evidence-Based Medical Interventions for Prevention and Treatment. Clinical Obstetrics & Gynecology, 53, 165-181. http://dx.doi.org/10.1097/ GRF.0b013e3181ce0965 [24] Heilmann, L., Wild, C., Hojnacki, B. and Pollow, K. (2006) Successful Treatment of Life-Threatening Bleeding after Cesarean Section with Recombinant Activated Factor VII. Clinical and Applied Thrombosis/Hemostasis, 12, 227-229. http://dx.doi.org/10.1177/107602960601200213 [25] Levy, J.H., Dutton, R.P., Hemphill III, J.C., Shander, A., Cooper, D., Paidas, M.J., Kessler, C.M., Holcomb, J.B. and Lawson, J.H. (2010) Hemostasis Summit Participants: Multidisciplinary Approach to the Challenge of Hemostasis. Anesthesia & Analgesia, 110, 354-364.
http://dx.doi.org/10.1213/ANE.0b013e3181c84ba5 [26] Fuller, A.J. and Bucklin, B. (2007) Blood Component Therapy in Obstetrics. Obstetrics and Gynecology Clinics of North America, 34, 443-458. http://dx.doi.org/10.1016/j.ogc.2007.06.003 [27] Prendiville, W.J., Harding, J.E., Elbourne, D.R. and Stirrat, G.M. (1988) The Bristol Third Stage Trial: Active versus Physiological Management of Third Stage of Labour. British Medical Journal, 297, 1295-1300. http://dx.doi.org/10.1136/bmj.297.6659.1295 [28] American College of Obstetricians and Gynecologists (2006) ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists, Number 76, October 2006: Postpartum Hemorrhage. Obstetrics and Gynecology, 108, 1039-1047. [29] Pacheco, L.D., Saade, G.R., Gei, A.F. and Hankins, G.D. (2011) Cutting-Edge Advances in the Medical Management of Obstetrical Hemorrhage. American Journal of Obstetrics & Gynecology, 205, 526-532. http://dx.doi.org/10.1016/j.ajog.2011.06.009 [30] Shakur, H., Elbourne, D., Gülmezoglu, M., Alfirevic, Z., Ronsmans, C., Allen, E. and Roberts, I. (2010) The WOMAN Trial (World Maternal Antifibrinolytic Trial): Tranexamic Acid for the Treatment of Postpartum Haemorrhage: An International Randomised, Double Blind Placebo Controlled Trial. Trials, 11, 40. http://dx.doi.org/10.1186/1745-6215-11-40 [31] Wikkelsoe, A.J., Afshari, A., Stensballe, J., Langhoff-Roos, J., Albrechtsen, C., Ekelund, K., Hanke, G., Sharif, H.F., Mitchell, A.U., Svare, J., et al. (2012) The FIB-PPH Trial: Fibrinogen Concentrate as Initial Treatment for Postpartum Haemorrhage: Study Protocol for a Randomised Controlled Trial. Trials, 13, 110. http://dx.doi.org/10.1186/1745-6215-13-110