Abstract
Objective: To identify current treatment strategies for postpartum hemorrhage used by obstetricians (OB/GYNs) and hematologists (HEMs). Study Design: We conducted a survey of OB/GYNs (n = 220) and HEMs (n = 30) to describe the characteristics of current treatment strategies for postpartum hemorrhage. Surveys were administered via a structured questionnaire on a secure internet website from 5 - 12 October 2009. Results: The majority of OB/GYN and HEM respondents were practicing in a community hospital environment (77%). Of the OB/GYNs, the majority practiced at hospitals with over 2000 deliveries per year (77%). A majority (58%) of OB/GYNs were affiliated with hospitals that lacked a massive transfusion protocol to treat severe postpartum hemorrhage. Subsequent to uterine massage and additional oxytocin, the majority of OB/GYNs (73%), preferred the administration of Methergine? as the next level of intervention for postpartum hemorrhage. There was considerable variability in response to specific treatment strategies for several hypothetical case scenarios; however, the large majority of OB/GYNs favored obstetrical procedures over interventional radiology or administration of rFVIIa. A large majority (77%) of physicians who are familiar with rRVIIa as treatment for postpartum hemorrhage reported being very satisfied with the agent for this indication. Conclusions: An established, systematic treatment strategy among OB/GYNs emerged only in the case of mild postpartum hemorrhage.
Highlights
Acute postpartum hemorrhage is the leading cause of global maternal mortality, and a principal contributor to maternal morbidity [1]
In the spectrum of obstetrical emergencies, massive obstetrical hemorrhage and shoulder dystocia are two of the most anxiety provoking situations encountered by obstetrical care providers
Whereas the management of shoulder dystocia can be successfully managed by an algorithmic approach, massive obstetrical hemorrhage requires individualized management of each patient to decrease maternal morbidity and mortality
Summary
Acute postpartum hemorrhage is the leading cause of global maternal mortality, and a principal contributor to maternal morbidity [1]. While recommendations for the management of shoulder dystocia have not changed greatly in recent years, the effective management of massive obstetrical hemorrhage has evolved to include a variety of medical and surgical strategies as well as standardized institutional approaches shown to improve outcomes [4]. Whereas the management of shoulder dystocia can be successfully managed by an algorithmic approach, massive obstetrical hemorrhage requires individualized management of each patient to decrease maternal morbidity and mortality. The ability of an obstetrical provider to effectively manage patients with postpartum hemorrhage is largely dependent on the individual’s residency training, personal experience and familiarity with the recommendations and controversies in the most current literature. The most common scenario involves the obstetric provider, managing a case of postpartum hemorrhage based his or her own practice habits on perhaps the assistance of Maternal Fetal Medicine or Hematology consultant
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