Evaluation and management of postpartum hemorrhage: consensus from an international expert panel
Evaluation and management of postpartum hemorrhage: consensus from an international expert panel
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DOI：
10.1111/trf.12550
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发表时间：
2014-07-01
期刊：
影响因子：
2.9
通讯作者：
Winikoff, Rochelle
中科院分区：
文献类型：
--
作者：
Abdul-Kadir, Rezan;McLintock, Claire;Winikoff, Rochelle
背景：产后出血 (PPH) 仍然是全世界孕产妇发病和死亡的主要原因之一，尽管缺乏精确的定义，无法获得有关 PPH 绝对患病率的准确数据。 研究设计和方法：产科、妇科、血液学、输血和麻醉学领域的国际专家小组对文献进行了全面审查。在 2011 年 11 月的一次会议上，专家组就严重产后出血的定义达成一致，该定义将识别那些处于不良临床结果高风险的女性。结果：专家组就严重持续性（持续性）产后出血的以下定义达成一致：“出生后 24 小时内活动性出血 >1000 mL，尽管使用了一线宫缩剂和子宫按摩等初步措施，但仍持续出血。”随后开发了严重持续性 PPH 的治疗算法。初步评估包括失血量测量和产后出血严重程度的临床评估。一旦诊断出持续性（持续性）产后出血，应立即进行凝血筛查，以指导后续治疗。如果初始措施未能止血且子宫收缩乏力持续存在，则应采取二线和三线（如果需要）干预措施。这些包括机械或外科手术，即宫内球囊填塞或止血支架缝合，子宫切除术作为无法控制的 PPH 的最终手术选择。药物选择包括止血剂（氨甲环酸），及时输血和血浆制品在持续性和严重的 PPH 中发挥着重要作用。结论：医疗保健专业人员的早期、积极和协调的干预对于最大限度地减少失血量至关重要，以确保在治疗患有严重、持续性 PPH 的女性时获得最佳的临床结果。
BACKGROUND: Postpartum hemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide, although the lack of a precise definition precludes accurate data of the absolute prevalence of PPH.STUDY DESIGN AND METHODS: An international expert panel in obstetrics, gynecology, hematology, transfusion, and anesthesiology undertook a comprehensive review of the literature. At a meeting in November 2011, the panel agreed on a definition of severe PPH that would identify those women who were at a high risk of adverse clinical outcomes.RESULTS: The panel agreed on the following definition for severe persistent (ongoing) PPH: "Active bleeding >1000 mL within the 24 hours following birth that continues despite the use of initial measures including first-line uterotonic agents and uterine massage." A treatment algorithm for severe persistent PPH was subsequently developed. Initial evaluations include measurement of blood loss and clinical assessments of PPH severity. Coagulation screens should be performed as soon as persistent (ongoing) PPH is diagnosed, to guide subsequent therapy. If initial measures fail to stop bleeding and uterine atony persists, second-and third-line (if required) interventions should be instated. These include mechanical or surgical maneuvers, i.e., intrauterine balloon tamponade or hemostatic brace sutures with hysterectomy as the final surgical option for uncontrollable PPH. Pharmacologic options include hemostatic agents (tranexamic acid), with timely transfusion of blood and plasma products playing an important role in persistent and severe PPH.CONCLUSION: Early, aggressive, and coordinated intervention by health care professionals is critical in minimizing blood loss to ensure optimal clinical outcomes in management of women with severe, persistent PPH.