Evaluation and management of postpartum hemorrhage: Consensus from an international expert panel

Rezan Abdul-Kadir, Claire McLintock, Anne Sophie Ducloy, Hazem El-Refaey, Adrian England, Augusto B. Federici, Chad A. Grotegut, Susan Halimeh, Jay H. Herman, Stefan Hofer, Andra H. James, Peter A. Kouides, Michael J. Paidas, Flora Peyvandi, Rochelle Winikoff

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

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 >1000mL 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.

Original languageEnglish
Pages (from-to)1756-1768
Number of pages13
JournalTransfusion
Volume54
Issue number7
DOIs
Publication statusPublished - 2014

Fingerprint

Postpartum Hemorrhage
Hemostatics
Uterine Inertia
Hemorrhage
Tranexamic Acid
Balloon Occlusion
Braces
Anesthesiology
Massage
Maternal Mortality
Hematology
Hysterectomy
Gynecology
Sutures
Obstetrics
Parturition
Morbidity
Delivery of Health Care

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

Abdul-Kadir, R., McLintock, C., Ducloy, A. S., El-Refaey, H., England, A., Federici, A. B., ... Winikoff, R. (2014). Evaluation and management of postpartum hemorrhage: Consensus from an international expert panel. Transfusion, 54(7), 1756-1768. https://doi.org/10.1111/trf.12550

Evaluation and management of postpartum hemorrhage : Consensus from an international expert panel. / Abdul-Kadir, Rezan; McLintock, Claire; Ducloy, Anne Sophie; El-Refaey, Hazem; England, Adrian; Federici, Augusto B.; Grotegut, Chad A.; Halimeh, Susan; Herman, Jay H.; Hofer, Stefan; James, Andra H.; Kouides, Peter A.; Paidas, Michael J.; Peyvandi, Flora; Winikoff, Rochelle.

In: Transfusion, Vol. 54, No. 7, 2014, p. 1756-1768.

Research output: Contribution to journalArticle

Abdul-Kadir, R, McLintock, C, Ducloy, AS, El-Refaey, H, England, A, Federici, AB, Grotegut, CA, Halimeh, S, Herman, JH, Hofer, S, James, AH, Kouides, PA, Paidas, MJ, Peyvandi, F & Winikoff, R 2014, 'Evaluation and management of postpartum hemorrhage: Consensus from an international expert panel', Transfusion, vol. 54, no. 7, pp. 1756-1768. https://doi.org/10.1111/trf.12550
Abdul-Kadir R, McLintock C, Ducloy AS, El-Refaey H, England A, Federici AB et al. Evaluation and management of postpartum hemorrhage: Consensus from an international expert panel. Transfusion. 2014;54(7):1756-1768. https://doi.org/10.1111/trf.12550
Abdul-Kadir, Rezan ; McLintock, Claire ; Ducloy, Anne Sophie ; El-Refaey, Hazem ; England, Adrian ; Federici, Augusto B. ; Grotegut, Chad A. ; Halimeh, Susan ; Herman, Jay H. ; Hofer, Stefan ; James, Andra H. ; Kouides, Peter A. ; Paidas, Michael J. ; Peyvandi, Flora ; Winikoff, Rochelle. / Evaluation and management of postpartum hemorrhage : Consensus from an international expert panel. In: Transfusion. 2014 ; Vol. 54, No. 7. pp. 1756-1768.
@article{58ac2cb89cb348189e69dececb138e47,
title = "Evaluation and management of postpartum hemorrhage: Consensus from an international expert panel",
abstract = "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 >1000mL 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.",
author = "Rezan Abdul-Kadir and Claire McLintock and Ducloy, {Anne Sophie} and Hazem El-Refaey and Adrian England and Federici, {Augusto B.} and Grotegut, {Chad A.} and Susan Halimeh and Herman, {Jay H.} and Stefan Hofer and James, {Andra H.} and Kouides, {Peter A.} and Paidas, {Michael J.} and Flora Peyvandi and Rochelle Winikoff",
year = "2014",
doi = "10.1111/trf.12550",
language = "English",
volume = "54",
pages = "1756--1768",
journal = "Transfusion",
issn = "0041-1132",
publisher = "Blackwell Publishing Inc.",
number = "7",

}

TY - JOUR

T1 - Evaluation and management of postpartum hemorrhage

T2 - Consensus from an international expert panel

AU - Abdul-Kadir, Rezan

AU - McLintock, Claire

AU - Ducloy, Anne Sophie

AU - El-Refaey, Hazem

AU - England, Adrian

AU - Federici, Augusto B.

AU - Grotegut, Chad A.

AU - Halimeh, Susan

AU - Herman, Jay H.

AU - Hofer, Stefan

AU - James, Andra H.

AU - Kouides, Peter A.

AU - Paidas, Michael J.

AU - Peyvandi, Flora

AU - Winikoff, Rochelle

PY - 2014

Y1 - 2014

N2 - 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 >1000mL 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.

AB - 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 >1000mL 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.

UR - http://www.scopus.com/inward/record.url?scp=84904498377&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84904498377&partnerID=8YFLogxK

U2 - 10.1111/trf.12550

DO - 10.1111/trf.12550

M3 - Article

C2 - 24617726

AN - SCOPUS:84904498377

VL - 54

SP - 1756

EP - 1768

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 7

ER -