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Management of postpartum haemorrhage: from research into practice, a narrative review of the literature and the Cardiff experience

Collins, Peter W., Bell, Sarah, De Lloyd, Lucy and Collis, Rachel 2019. Management of postpartum haemorrhage: from research into practice, a narrative review of the literature and the Cardiff experience. International Journal of Obstetric Anesthesia 37 , pp. 106-117. 10.1016/j.ijoa.2018.08.008
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Postpartum haemorrhage (PPH) is caused by obstetric complications but may be exacerbated by haemostatic impairment. In a ten year programme of research we have established that haemostatic impairment is uncommon in moderate PPH and that fibrinogen falls earlier than other coagulation factors. Laboratory Clauss fibrinogen and the point of care surrogate measure of fibrinogen (Fibtem® A5 measured on the ROTEM® machine) are predictive biomarkers for progression from early to severe PPH, the need for blood transfusion and invasive procedures to control haemorrhage. Fibrinogen replacement is not required in PPH unless the plasma level falls below 2 g/L or the Fibtem A5 is below 12mm. Deficiencies of coagulation factors other than fibrinogen are uncommon even during severe PPH, and ROTEM monitoring can inform withholding FFP safely in most women. In the absence of placental abruption, clinically significant thrombocytopenia is uncommon unless the platelet count is low before the bleed started, or very large bleeds (>5000 mL) occur. Measuring blood loss is feasible in routine practice during PPH and is more accurate than estimation. These research findings have been collated to design an ongoing quality improvement programme for all maternity units in Wales called OBS Cymru (Wales) (The Obstetric Bleeding Strategy for Wales) .

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Elsevier
ISSN: 0959-289X
Date of First Compliant Deposit: 18 September 2018
Date of Acceptance: 22 August 2018
Last Modified: 08 May 2019 02:51

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