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تعداد آیتم قابل مشاهده باقیمانده: 4

Potential interventions for treatment of postpartum hemorrhage

Potential interventions for treatment of postpartum hemorrhage
Pharmacologic interventions
Drug Dosing
Oxytocin (first-line) 10 to 40 units in 500 to 1000 mL normal saline infused at a rate sufficient to control atony or 5 to 10 units IM.
Tranexamic acid (adjunctive agent) 1 g (10 mL of a 100 mg/mL solution) is infused over 10 to 20 minutes; if bleeding persists after 30 minutes, a second 1 g dose is administered.
Ergots (second-line) Methylergonovine 0.2 mg IM or ergonovine 0.2 mg IM every 2 to 4 hours.
Carboprost (second-line) 0.25 mg IM every 15 to 90 minutes up to 8 doses.
Misoprostol 400 to 800 mcg sublingually as a single dose. Most useful in settings where injectable uterotonics are unavailable or contraindicated (eg, hypertension, asthma)
Recombinant human factor VIIa (adjunctive agent) 50 to 100 mcg/kg. It is preferable to start with a low dose (40 or 60 mcg/kg). The dose may be repeated once in 15 to 30 minutes if there is no response. Additional doses are unlikely to be effective.
Surgical interventions
  • Repair lacerations
  • Curettage
  • Uterine compression suture (eg, B-Lynch suture)
  • Uterine artery ligation
  • Utero-ovarian artery ligation or cross clamp
  • Pelvic packing
  • Uterine tourniquet
  • Focal myometrial excision
  • Use of fibrin glues and patches to cover areas of oozing and promote clotting
  • Placement of figure 8 sutures or other hemostatic sutures directly into the placental bed
  • Resuscitative endovascular balloon occlusion of the aorta (REBOA)
  • Internal iliac artery (hypogastric artery) ligation
  • Aortic/iliac artery compression
  • Hysterectomy, supracervical
  • Hysterectomy, total
Interventional endovascular procedures
  • Selective arterial embolization
  • Intermittent aortic balloon occlusion
  • Common iliac artery balloon occlusion
Blood bank
  • Packed red blood cells
  • Platelets
  • Fresh frozen plasma
  • Cryoprecipitate
Nonsurgical interventions
  • Uterine massage
  • Intravenous fluids
  • Intrauterine tamponade
    • Intrauterine balloon or alternative device (eg, bladder catheter bulb, Sengstaken-Blakemore tube)
    • Intrauterine vacuum
    • Uterine packing (eg, 4-inch gauge packing)
Consultations
  • General surgery
  • Trauma surgery
  • Anesthesia team
  • Interventional radiology
  • Gynecologic oncology
  • Urology
IM: intramuscular; IV: intravenous; kg: kilogram; mcg: micrograms.
Data from:
  1. Dahlke JD, Mendoz-Figueroa H, Maggio L, et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015; 213.e1.
  2. Bienstock JL, Ahizechukwu CE, Hueppchen NA. Postpartum hemorrhage. N Engl J Med 2021; 384:1635.
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