The use of recombinant factor VIIa in severe postpartum hemorrhage

Abstract

Severe postpartum hemorrhage (SPPH) from uterine bleeding and profuse hemorrhage of pelvic origin may lead to hemorrhagic shock, consumption coagulopathy and disseminated intravascular coagulopathy (DIC). These are life-threatening situations that require fast and efficient treatment, including contraction of the uterus, removal of the placenta, correction of coagulopathy, ligation of uterine or internal iliac arteries, hysterectomy or arterial embolization (1). Recombinant activated factor VII (rFVIIa) has been shown to correct severe coagulopathy and control life-threatening bleeding (2, 3). The use of rFVIIa in obstetrics is also encouraging (4, 5). Ten women with SPPH and bleeding were treated during 2000–2003 with rFVIIa. Coagulopathy was corrected with packed cells, fresh frozen plasma, cryoprecipitate and platelets. rFVIIa (NovoSeven®, Novo Nordisk, A/S Bagsvaerd, Denmark) was administered intravenously at doses of 90–100 µg/kg (7.2–19 mg). The indication and timing were continuous bleeding, after hysterectomy or surgical hemostasis. The dosage used was the one effective in trauma (3). The results of the treatment are shown in Tables I and II. The use of rFVIIa with DIC was uneventful. The prophylactic use and the preferred time for injection are still unclear. One to two (up to 19 mg) injections were sufficient in our patients. rFVIIa was successfully used as an additional treatment for severe postpartum and intraabdominal hemorrhage even in the presence of DIC. In three patients, rFVIIa saved their lives. It significantly reduced the blood loss and enabled surgical hemostasis. rFVIIa is recommended when preservation of the uterus is required and when arterial embolization is not available. Dose and timing of administration need further elucidation.