To guide the optimal use of blood products and to clarify the indications for prohemostatic drugs in obstetric hemorrhage.
The literature emphasizes the usefulness of transfusing packed red blood cells, fresh frozen plasma and platelets earlier and in defined ratios to prevent dilutional coagulopathy during obstetric hemorrhage. The value of fibrinogen concentrate and prohemostatic drugs such as tranexamic acid and recombinant factor VIIa is also pointed out.
It seems reasonable to use blood products for transfusion earlier and in a 1: 1 fresh frozen plasma: red blood cell ratio during acute obstetric hemorrhage; however, this analysis is mainly based on trauma literature. Fibrinogen concentrate should be added if the fibrinogen plasma level remains below 1.0 g l−1 and perhaps even as soon as it falls below 1.5–2.0 g l−1; the addition of tranexamic acid (1 g) is cheap, likely to be useful and appears safe. Data on the proactive administration of platelets are insufficient to recommend this practice routinely. Presently, recombinant factor VIIa (60–90 μg kg−1) is advocated only after failure of other conventional therapies, including embolization or conservative surgery, but prior to obstetric hysterectomy. Prospective randomized controlled trials are highly desirable.
aDépartement d'Anesthésie Réanimation, Hôpital Antoine Béclère, Groupe Hospitalier Universitaire Paris Sud, Assistance Publique-Hôpitaux de Paris, Université Paris XI, Clamart, France
bDépartement d'Anesthésie Réanimation, Maternité Port Royal, Hôpital Cochin, Groupement Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, Université Paris V – René Descartes, France
cINSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Université Paris VI, Paris, France
Correspondence to Frédéric J. Mercier, Département d'Anesthésie-Réanimation Chirurgicale, Hôpital Antoine Béclère, 157, rue de la Porte de Trivaux, 92141 Clamart Cedex BP 405, France Tel: +33 1 45 37 42 73; fax: +33 1 45 37 49 85; e-mail: email@example.com