8. Obstetric Haemorrhage
- Ian Johnston2,
- William Harrop-Griffiths3 and
- Leslie Gemmell4
Published Online: 10 NOV 2011
Copyright © 2012 The Association of Anaesthetists of Great Britain and Ireland (AAGBI)
AAGBI Core Topics in Anaesthesia
How to Cite
Levy, D. (2011) Obstetric Haemorrhage, in AAGBI Core Topics in Anaesthesia (eds I. Johnston, W. Harrop-Griffiths and L. Gemmell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118227978.ch8
Raigmore Hospital, Inverness, UK
Imperial College Healthcare NHS Trust, London, UK
Wrexham Maelor Hospital, Wrexham, UK
- Published Online: 10 NOV 2011
- Published Print: 29 NOV 2011
Print ISBN: 9780470658628
Online ISBN: 9781118227978
- obstetric haemorrhage;
- maternal mortality, morbidity;
- placental abruption, and APH;
- antepartum (APH) or postpartum (PPH);
- UK triennial CMACE report;
- staff multidisciplinary ‘fire drills’;
- Lieno-renal axis aneurysms;
- Care Quality Commission (CQC);
- emergency anaesthesia
• Obstetric haemorrhage is a major cause of maternal mortality and morbidity throughout the world.
• Placental abruption and placenta praevia are the major causes of antepartum haemorrhage.
• The syndrome of cardiovascular collapse, hypoxaemia and coagulopathy, previously known as ‘amniotic fluid embolism’, has been renamed ‘anaphylactoid syndrome of pregnancy’ to reflect an immune-mediated aetiology.
• The four Ts – Tone (uterine atony), Tissue, Trauma and Thrombin (coagulopathy) – are the major causes of postpartum haemorrhage.
• Placenta accreta is an abnormally deep placental attachment to the uterine muscle. The National Patient Safety Agency has published a six-element care bundle for women undergoing caesarean section and who are at high risk of placenta accreta (principally placenta praevia after a previous caesarean section) and life-threatening haemorrhage.
• Interventional radiology offers the facility to place balloon-tipped catheters in the uterine arteries before elective, high-risk surgery. Embolization of the anterior branches of the internal iliac arteries can resolve unanticipated postpartum haemorrhage whilst preserving the uterus.
• Uterine compressive sutures and intra-uterine balloon tamponade have been used separately and in combination.
• Based on current regimens for major trauma, red cells and fresh frozen plasma have been recommended in a 1:1 ratio with pre-emptive platelet transfusion. There should be a low threshold for giving fibrinogen concentrate.
• Recombinant Factor VIIa has been recommended after failure of conventional therapies but before caesarean hysterectomy.
• Once haemorrhage has been controlled definitively, the need for thromboprophylaxis must not be forgotten.