Successful treatment with recombinant blood factor VIIa in severe postpartum hemorrhage-induced disseminated intravascular coagulation

Abstract

Obstetric hemorrhage is the leading cause of maternal morbidity and mortality worldwide. Uterine atony leading to postpartum hemorrhage (PPH) is the most common type seen [1]. Other factors include genital tract lacerations, retained placenta, uterine inversion, and acquired or inherited coagulopathy. The World Health Organization defines PPH as a blood loss in excess of 500 mL after delivery; the common sites for blood loss include the uterus, cervix, vagina, and perineum [2]. Massive PPH (> 1 L) accounts for > 10% of all maternal deaths and can lead to permanent morbidity [3]. Therapeutic management strategies include uterine compression with massage or manual compression, compression sutures (B-Lynch procedure), increasing intrauterine pressure with balloon catheters or gauze packing, and/or uterotonic agents or intravenous hemostatic agents such as tranexamic acid (Transamin) and recombinant activated blood factor VIIa (rfVIIa) [4]. We describe a case of refractory massive PPH. The bleeding persisted even though vaginal packing and uterine artery embolization were administered. Disseminated intravascular coagulation (DIC) then developed, which we successfully corrected with two injections of rfVIIa. Interventions with rfVIIa in cases of PPH have been reported in the past decade. The first report of the use of rfVIIa in an obstetric patient with DIC following PPH was by Plaat [5] in