OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Cynthia A. WongThe role of recombinant activated factor VII in obstetric hemorrhageAhonen, Jouni Author Information Department of Anesthesia, Women's Clinic, Helsinki University Hospital, Helsinki, Finland Correspondence to Jouni Ahonen, Staff anesthesiologists, MD, PhD, Lampikuja 1 B 8, FIN-01710 Vantaa, Finland. Tel: +358 50 4271852; e-mail: [email protected] Current Opinion in Anaesthesiology: June 2012 - Volume 25 - Issue 3 - p 309-314 doi: 10.1097/ACO.0b013e3283532007 Buy Metrics Abstract Purpose of review To review the literature regarding the use of recombinant activated factor FVII (rFVIIa) in the treatment of postpartum hemorrhage (PPH). Recent findings The previous and recent case reports and case series suggest a potential benefit of rFVIIa in the management of severe PPH refractory to standard treatment. However, the lack of randomized controlled studies limits the value of the available data. rFVIIa cannot work optimally if there is a shortage of the basic components of the coagulation cascade such as fibrinogen. New experimental data suggest that rFVIIa can relocate into the extravascular space and remain functionally active which may prolong its hemostatic effect longer than the short circulatory half-life indicates. Summary Although some preliminary guidelines have been published, the case reports and case series illustrate that the practice of using rFVIIa in PPH is far from uniform. rFVIIa should usually not be used to compensate for an inadequate transfusion therapy. Therefore, early and effective administration of red blood cells, fresh frozen plasma, fibrinogen concentrate (or cryoprecipitate), and platelets as well as the control of uterine atony are essential before considering administration of rFVIIa in the treatment of PPH. © 2012 Lippincott Williams & Wilkins, Inc.