Postpartum haemorrhage in high-resource settings: Variations in clinical management and future research directions based on a comparative study of national guidelines.
clinical guidelines
obstetric haemorrhage
postpartum haemorrhage
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
12 2023
12 2023
Historique:
revised:
15
04
2023
received:
25
12
2022
accepted:
04
05
2023
medline:
6
11
2023
pubmed:
1
6
2023
entrez:
31
5
2023
Statut:
ppublish
Résumé
To compare guidelines from eight high-income countries on prevention and management of postpartum haemorrhage (PPH), with a particular focus on severe PPH. Comparative study. High-resource countries. Women with PPH. Systematic comparison of guidance on PPH from eight high-income countries. Definition of PPH, prophylactic management, measurement of blood loss, initial PPH-management, second-line uterotonics, non-pharmacological management, resuscitation/transfusion management, organisation of care, quality/methodological rigour. Our study highlights areas where strong evidence is lacking. There is need for a universal definition of (severe) PPH. Consensus is required on how and when to quantify blood loss to identify PPH promptly. Future research may focus on timing and sequence of second-line uterotonics and non-pharmacological interventions and how these impact maternal outcome. Until more data are available, different transfusion strategies will be applied. The use of clear transfusion-protocols are nonetheless recommended to reduce delays in initiation. There is a need for a collaborative effort to develop standardised, evidence-based PPH guidelines. Definitions of (severe) PPH varied as to the applied cut-off of blood loss and incorporation of clinical parameters. Dose and mode of administration of prophylactic uterotonics and methods of blood loss measurement were heterogeneous. Recommendations on second-line uterotonics differed as to type and dose. Obstetric management diverged particularly regarding procedures for uterine atony. Recommendations on transfusion approaches varied with different thresholds for blood transfusion and supplementation of haemostatic agents. Quality of guidelines varied considerably.
Identifiants
pubmed: 37259184
doi: 10.1111/1471-0528.17551
doi:
Substances chimiques
Oxytocics
0
Oxytocin
50-56-6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1639-1652Informations de copyright
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
Références
van Stralen G, von Schmidt Auf Altenstadt JF, Bloemenkamp KW, van Roosmalen J, Hukkelhoven CW. Increasing incidence of postpartum hemorrhage: the Dutch piece of the puzzle. Acta Obstet Gynecol Scand. 2016;95(10):1104-10.
Kaelin Agten A, Passweg D, von Orelli S, Ringel N, Tschudi R, Tutschek B. Temporal trends of postpartum haemorrhage in Switzerland: a 22-year retrospective population-based cohort study. Swiss Med Wkly. 2017;147:w14551.
Les morts maternelles en France: mieux comprendre pour mieux prévenir. 6e rapport de l’Enquête Nationale Confidentielle sur les Morts Maternelles (ENCMM), 2013-2015. Saint-Maurice: Santé Publique France; 2021. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-cardiovasculaires-et-accident-vasculaire-cerebral/maladies-vasculaires-de-la-grossesse/documents/enquetes-etudes/les-morts-maternelles-en-france-mieux-comprendre-pour-mieux-prevenir.-6e-rapport-de-l-enquete-nationale-confidentielle-sur-les-morts-maternelles
Deneux-Tharaux C, Saucedo M. Epidemiology of maternal mortality in France, 2010-2012. Gynecol Obstet Fertil Senol. 2017;45(12s):S8-s21.
Donati S, Maraschini A, Lega I, D’Aloja P, Buoncristiano M, Manno V. Maternal mortality in Italy: results and perspectives of record-linkage analysis. Acta Obstet Gynecol Scand. 2018;97(11):1317-24.
Dupont C, Deneux-Tharaux C, Touzet S, Colin C, Bouvier-Colle MH, Lansac J, et al. Clinical audit: a useful tool for reducing severe postpartum haemorrhages? International J Qual Health Care. 2011;23(5):583-9.
Donati S, Buoncristiano M, Lega I, D’Aloja P, Maraschini A. The Italian obstetric surveillance system: implementation of a bundle of population-based initiatives to reduce haemorrhagic maternal deaths. PLoS One. 2021;16(4):e0250373.
Hughes D. Cultural influences on medical knowledge. In: Schramme T, Edwards S, editors. Handbook of the philosophy of medicine. Dordrecht: Springer; 2017.
Dahlke JD, Mendez-Figueroa H, Maggio L, Hauspurg AK, Sperling JD, Chauhan SP, et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol. 2015;213(1):76.e1-10.
Sentilhes L, Goffinet F, Vayssiere C, Deneux-Tharaux C. Comparison of postpartum haemorrhage guidelines: discrepancies underline our lack of knowledge. BJOG. 2017;124(5):718-22.
Greene RA, McKernan J, Manning E, Corcoran P, Byrne B, Cooley S, et al. Major obstetric haemorrhage: incidence, management and quality of care in Irish maternity units. Eur J Obstet Gynecol Reprod Biol. 2021;257:114-20.
Kramer MS, Berg C, Abenhaim H, Dahhou M, Rouleau J, Mehrabadi A, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209(5):449.e1-7.
Flood M, McDonald SJ, Pollock W, Cullinane F, Davey MA. Incidence, trends and severity of primary postpartum haemorrhage in Australia: a population-based study using Victorian Perinatal Data Collection data for 764 244 births. Aust N Z J Obstet Gynaecol. 2019;59(2):228-34.
Dzakpasu S, Deb-Rinker P, Arbour L, Darling EK, Kramer MS, Liu S, et al. Severe maternal morbidity in Canada: temporal trends and regional variations, 2003-2016. J Obstet Gynaecol Can. 2019;41(11):1589-98.e16.
WHO Guidelines Approved by the Guidelines Review Committee. WHO recommendations for the prevention and treatment of postpartum Haemorrhage. Geneva: World Health Organization; 2012.
Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D, et al. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet. 2022;157(Suppl 1):3-50.
Sentilhes L, Vayssière C, Deneux-Tharaux C, Aya AG, Bayoumeu F, Bonnet MP, et al. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J Obstet Gynecol Reprod Biol. 2016;198:12-21.
NVOG richtlijn postpartum hemorrhagie. 2018. Available from: https://www.nvog.nl/wp-content/uploads/2018/02/Hemorrhagia-postpartum-HPP-3.0-14-11-2013.pdf
Schlembach D, Helmer H, Henrich W, von Heymann C, Kainer F, Korte W, et al. Peripartum haemorrhage, diagnosis and therapy. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry No. 015/063, March 2016). Geburtshilfe Frauenheilkd. 2018;78(4):382-99.
Mavrides EAS, Chandraharan E, Collins P, Green L, Hunt BJ, Riris S, et al. Prevention and management of post-partum haemorrhage: green-top guideline No 52. BJOG. 2017;124:e106-49.
Practice Bulletin No. 183 summary: postpartum hemorrhage. Obstet Gynecol. 2017;130(4):923-5.
Emorragia post partum: come prevenirla, come curarla. Sistema nazionale per le linee guida. 2016. Available from: https://www.epicentro.iss.it/itoss/pdf/SNLG_EPP-2016web_corrige.pdf
Leduc D, Senikas V, Lalonde AB. No. 235-active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. J Obstet Gynaecol Can. 2018;40(12):e841-55.
Gynaecologiststs RANZCOG. RANZCOG statement. Management of postpartum haemorrhage. Women's Health Committee and RANZCOG Board and Council, editors; 2017.
Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182(18):E839-42.
Pritchard JABR, Dickey JC, Wiggins KM. Blood volume changes in pregnancy and the puerperium II. Red blood cell loss and changes in apparent blood volume during and following vaginal delivery, cesarean section, and cesarean section plus total hysterectomy. Am J Obstet Gynecol. 1962;84:1271-82.
Borovac-Pinheiro A, Pacagnella RC, Cecatti JG, Miller S, El Ayadi AM, Souza JP, et al. Postpartum hemorrhage: new insights for definition and diagnosis. Am J Obstet Gynecol. 2018;219(2):162-8.
Rath WH. Postpartum hemorrhage - update on problems of definitions and diagnosis. Acta Obstet Gynecol Scand. 2011;90(5):421-8.
Anger H, Durocher J, Dabash R, Winikoff B. How well do postpartum blood loss and common definitions of postpartum hemorrhage correlate with postpartum anemia and fall in hemoglobin? PLoS One. 2019;14(8):e0221216.
Hamm RF, Wang EY, Bastek JA, Srinivas SK. Assessing reVITALize: should the definition of postpartum hemorrhage differ by mode of delivery? Am J Perinatol. 2017;34(5):503-7.
Muñoz M, Stensballe J, Ducloy-Bouthors AS, Bonnet MP, De Robertis E, Fornet I, et al. Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement. Blood Transfus. 2019;17(2):112-36.
Adnan N, Conlan-Trant R, McCormick C, Boland F, Murphy DJ. Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: randomised controlled trial. BMJ. 2018;362:k3546.
Charles D, Anger H, Dabash R, Darwish E, Ramadan MC, Mansy A, et al. Intramuscular injection, intravenous infusion, and intravenous bolus of oxytocin in the third stage of labor for prevention of postpartum hemorrhage: a three-arm randomized control trial. BMC Pregnancy Childbirth. 2019;19(1):38.
Diaz V, Abalos E, Carroli G. Methods for blood loss estimation after vaginal birth. Cochrane Database Syst Rev. 2018;9(9):CD010980.
Powell E, James D, Collis R, Collins PW, Pallmann P, Bell S. Introduction of standardized, cumulative quantitative measurement of blood loss into routine maternity care. J Matern Fetal Neonatal Med. 2022;35(8):1491-7.
Bhatt A, Hughes-Hogan L, Mitchell T, Nair S, Chuang M, Chen SL, et al. Impact of measuring quantification of blood loss versus estimation of blood loss during cesarean deliveries. Int J Gynaecol Obstet. 2023;160(2):670-7.
Schmitz T, Tararbit K, Dupont C, Rudigoz RC, Bouvier-Colle MH, Deneux-Tharaux C, et al. Prostaglandin E2 analogue sulprostone for treatment of atonic postpartum hemorrhage. Obstet Gynecol. 2011;118(2 Pt 1):257-65.
Vallera C, Choi LO, Cha CM, Hong RW. Uterotonic medications: oxytocin, methylergonovine, carboprost, misoprostol. Anesthesiol Clin. 2017;35(2):207-19.
Gallos ID, Papadopoulou A, Man R, Athanasopoulos N, Tobias A, Price MJ, et al. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev. 2018;12(12):CD011689.
Bateman BT, Huybrechts KF, Hernandez-Diaz S, Liu J, Ecker JL, Avorn J. Methylergonovine maleate and the risk of myocardial ischemia and infarction. Am J Obstet Gynecol. 2013;209(5):459.e1-13.
Kayem G, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M. Specific second-line therapies for postpartum haemorrhage: a national cohort study. BJOG. 2011;118(7):856-64.
Kayem G, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M, et al. Uterine compression sutures for the management of severe postpartum hemorrhage. Obstet Gynecol. 2011;117(1):14-20.
Soro MP, Denys A, de Rham M, Baud D. Short & long term adverse outcomes after arterial embolisation for the treatment of postpartum haemorrhage: a systematic review. Eur Radiol. 2017;27(2):749-62.
Eggel B, Bernasconi M, Quibel T, Horsch A, Vial Y, Denys A, et al. Gynecological, reproductive and sexual outcomes after uterine artery embolization for post-partum haemorrage. Sci Rep. 2021;11(1):833.
Kellie FJ, Wandabwa JN, Mousa HA, Weeks AD. Mechanical and surgical interventions for treating primary postpartum haemorrhage. Cochrane Database Syst Rev. 2020;7(7):CD013663.
Sathe NA, Likis FE, Young JL, Morgans A, Carlson-Bremer D, Andrews J. Procedures and uterine-sparing surgeries for managing postpartum hemorrhage: a systematic review. Obstet Gynecol Surv. 2016;71(2):99-113.
Soyer P, Dohan A, Dautry R, Guerrache Y, Ricbourg A, Gayat E, et al. Transcatheter arterial embolization for postpartum hemorrhage: indications, technique, results, and complications. Cardiovasc Intervent Radiol. 2015;38(5):1068-81.
Park JK, Shin TB, Baek JC, Shin JK, Choi WJ, Lee SA, et al. Failure of uterine artery embolization for controlling postpartum hemorrhage. J Obstet Gynaecol Res. 2011;37(8):971-8.
Rossi AC, Lee RH, Chmait RH. Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: a systematic review. Obstet Gynecol. 2010;115(3):637-44.
van den Akker T, Brobbel C, Dekkers OM, Bloemenkamp KWM. Prevalence, indications, risk indicators, and outcomes of emergency peripartum hysterectomy worldwide: a systematic review and meta-analysis. Obstet Gynecol. 2016;128(6):1281-94.
Waters JH, Bonnet MP. When and how should i transfuse during obstetric hemorrhage? Int J Obstet Anesth. 2021;46:102973.
Nascimento B, Callum J, Tien H, Rubenfeld G, Pinto R, Lin Y, et al. Effect of a fixed-ratio (1:1:1) transfusion protocol versus laboratory-results-guided transfusion in patients with severe trauma: a randomized feasibility trial. CMAJ. 2013;185(12):E583-9.
Tapia NM, Chang A, Norman M, Welsh F, Scott B, Wall MJ Jr, et al. TEG-guided resuscitation is superior to standardized MTP resuscitation in massively transfused penetrating trauma patients. J Trauma Acute Care Surg. 2013;74(2):378-85. discussion 85-6.
Samama CM, Ickx B, Ozier Y, Steib A, Susen S, Godier A. The place of fibrinogen concentrates in the management of perioperative bleeding: a position paper from the Francophone Working Group on Perioperative Haemostasis (GIHP). Anaesth Crit Care Pain Med. 2018;37(4):355-65.
Cortet M, Deneux-Tharaux C, Dupont C, Colin C, Rudigoz RC, Bouvier-Colle MH, et al. Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. Br J Anaesth. 2012;108(6):984-9.
Ahmed S, Harrity C, Johnson S, Varadkar S, McMorrow S, Fanning R, et al. The efficacy of fibrinogen concentrate compared with cryoprecipitate in major obstetric haemorrhage - an observational study. Transfus Med. 2012;22(5):344-9.
Shakur H, Elbourne D, Gülmezoglu M, Alfirevic Z, Ronsmans C, Allen E, et al. The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial. Trials. 2010;11:40.
Sentilhes L, Daniel V, Deneux-Tharaux C, TRAAP2 Study Group and the Groupe de Recherche en Obstétrique et Gynécologie (GROG). TRAAP2 - TRAnexamic acid for preventing postpartum hemorrhage after cesarean delivery: a multicenter randomized, doubleblind, placebo- controlled trial - a study protocol. BMC Pregnancy Childbirth. 2020;20(1):63.
Sentilhes L, Sénat MV, Le Lous M, Winer N, Rozenberg P, Kayem G, et al. Tranexamic acid for the prevention of blood loss after cesarean delivery. N Engl J Med. 2021;384(17):1623-34.
Sentilhes L, Winer N, Azria E, Sénat M-V, Le Ray C, Vardon D, et al. Tranexamic acid for the prevention of blood loss after vaginal delivery. N Engl J Med. 2018;379(8):731-42.
Butwick AJ, Goodnough LT. Transfusion and coagulation management in major obstetric hemorrhage. Curr Opin Anaesthesiol. 2015;28(3):275-84.
Deleu F, Deneux-Tharaux C, Chiesa-Dubruille C, Seco A, Bonnet MP, EPIMOMS Study Group. A population-based analysis of French transfusion practices for women experiencing severe postpartum hemorrhage. Int J Obstet Anesth. 2020;42:11-9.
Bonnet MP, Deneux-Tharaux C, Dupont C, Rudigoz RC, Bouvier-Colle MH. Transfusion practices in postpartum hemorrhage: a population-based study. Acta Obstet Gynecol Scand. 2013;92(4):404-13.
Rijnhout TWH, Noorman F, van Waes OJF, van Bohemen M, Verhofstad MHJ, Hoencamp R. Massive transfusion protocols in The Netherlands. Consensus or confusion? Injury. 2022;53(1):49-53.
Rossignol M, Rozenberg A. Inter-hospital transfer for severe postpartum hemorrhage. J Gynecol Obstet Biol Reprod (Paris). 2014;43(10):1123-32.
Kulshrestha A, Singh J. Inter-hospital and intra-hospital patient transfer: recent concepts. Indian J Anaesth. 2016;60(7):451-7.
Main EK, Cape V, Abreo A, Vasher J, Woods A, Carpenter A, et al. Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative. Am J Obstet Gynecol. 2017;216(3):298.e1-11.