Latest advances in postpartum hemorrhage management. Issue 1 (May 2022)

• Record Type: Journal Article
• Authors: Kumaraswami, Sangeeta; Butwick, Alexander
• Is Part Of: Best practice & research. Volume 36:Issue 1(2022)
• Page Start: 123
• Page End: 134
• Publication Date: 2022-05
• Subjects: postpartum hemorrhage -- quantitative blood loss -- massive transfusion protocol -- tranexamic acid -- fibrinogen concentrate -- viscoelastic point-of-care tests; PPH Postpartum hemorrhage -- DIC Disseminated intravascular coagulation -- ACOG American College of Obstetricians and Gynecologists -- QBL Quantitation of blood loss -- POC Point-of-Care -- IVC Inferior vena cava -- PAS Placenta Accreta Spectrum -- CMQCC California Maternal Quality Care Collaborative -- RBC Red blood cells -- MTP Massive transfusion protocol -- FFP Fresh frozen plasma -- TACO Transfusion-associated circulatory overload -- TRALI Transfusion-associated acute lung injury -- RhD Rhesus D antigen -- ROTEM Rotational thromboelastometry -- TEG Thromboelastography -- EXTEM Screening test for hemostasis -- FIBTEM Screening test for hemostatsis -- TXA Tranexamic acid -- ABO Blood group types; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; Anesthesia -- Periodicals; Anesthetics -- Periodicals; Anesthesia; Anesthesiology; Periodicals; 617.9605
• DOI: 10.1016/j.bpa.2022.02.004
• Languages: English
• ISSNs: 1521-6869

Abstract

Abstract : Hemorrhage is the leading cause of maternal mortality worldwide. A maternal health priority is improving how healthcare providers prevent and manage postpartum hemorrhage (PPH). Because anesthesiologists can help facilitate how hospitals develop approaches for PPH prevention and anticipatory planning, we review the potential utility of PPH risk-assessment tools, bundles, and protocols. Anesthesiologists rely on clinical and diagnostic information for initiating and evaluating medical management. Therefore, we review modalities for measuring blood loss after delivery, which includes visual, volumetric, gravimetric, and colorimetric approaches. Point-of-care technologies for assessing changes in central hemodynamics (ultrasonography) and coagulation profiles (rotational thromboelastometry and thromboelastography) are also discussed. Anesthesiologists play a critical role in the medical and transfusion management of PPH. Therefore, we review blood ordering and massive transfusion protocols, fixed-ratio vs. goal-directed transfusion approaches, coagulation changes during PPH, and the potential clinical utility of the pharmacological adjuncts, tranexamic acid, and fibrinogen concentrate.