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The Use of Recombinant Activated FVII in Postpartum Hemorrhage

FRANCHINI, MASSIMO MD*; FRANCHI, MASSIMO MD, PhD; BERGAMINI, VALENTINO MD; MONTAGNANA, MARTINA MD; SALVAGNO, GIAN LUCA MD; TARGHER, GIOVANNI MD§; LIPPI, GIUSEPPE MD

Clinical Obstetrics & Gynecology:
doi: 10.1097/GRF.0b013e3181cc4378
Postpartum Hemorrhage
Abstract

Severe bleeding remains a leading cause of morbidity and mortality in obstetrics. The first-line standard treatment of massive postpartum hemorrhage (PPH) includes medical measures directed at improving uterine tone, replacement of lost intravascular volume, blood and coagulation factors, and surgical or invasive procedures. Recently, a number of case reports or case series have reported the successful “off-label” use of recombinant activated factor VII (rFVIIa) in PPH unresponsive to conventional treatments. In this review, a critical analysis of the published literature on the use of rFVIIa in severe PPH was performed. Overall, a total of 272 PPH women were collected among the largest case series and/or international registries. No randomized controlled trials have been conducted in this area. Currently, the literature data suggest that, at a median dose of 81.5 μg/kg, rFVIIa is effective in stopping or reducing bleeding in 85% of the cases. Finally, on the basis of the evidence from the literature and on own experience, we included some recommendations and an algorithm on the therapeutic role of rFVIIa in the management of PPH.

Author Information

*Immunohematology and Transfusion Center, Department of Pathology and Laboratory Medicine, University Hospital of Parma, Parma

Section of Obstetrics and Gynecology, Department of Mother-Child and Biology-Genetics

Section of Clinical Chemistry, Department of Biomedical and Morphological Sciences

§Section of Endocrinology, Department of Biomedical and Surgical Sciences, University of Verona, Verona, Italy

Correspondence: Massimo Franchini, MD, Immunohematology and Transfusion Center, Department of Pathology and Laboratory Medicine, University Hospital of Parma, Parma, Italy. E-mail: mfranchini@ao.pr.it

© 2010 Lippincott Williams & Wilkins, Inc.