Recombinant human factor VIIa prevents hysterectomy in severe postpartum hemorrhage: single center study
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Alexander W. Huber
Abstract
Objective: To evaluate the effectiveness of human recombinant activated factor VII (rhFVIIa, NovoSeven) in avoiding hysterectomy postpartum in the management of severe postpartum hemorrhage (PPH).
Methods: We performed a prospective cohort study at our university tertiary care center. Patients with severe post partum hemorrhage (blood loss >2000 mL) and failed medical and uterus-preserving surgical management, were treated with intravenous bolus administration of rhVIIa. Main outcome measures were cessation of bleeding, postpartum hysterectomy and thromboembolic events.
Results: In 20/22 patients included, PPH was caused primarily by uterine atony, including 7 (32%) with additional lower genital tract lesion; in two women, it was due to pathologic placentation (placenta increta, 9%). One case of amniotic fluid embolism and one woman with uterine inversion were included. Recombinant hFVIIa was successful in stopping the PPH and in preventing a hysterectomy in 20/22 women (91%). The remaining two patients with persistent bleeding despite rhFVIIa treatment, who underwent postpartum hysterectomy, had placenta increta. No thromboembolic event was noticed.
Conclusions: This study describes the largest single center series of rhFVIIa treatment for fertility preservation in severe postpartum hemorrhage published to date. Our data suggest that administration of rhFVIIa is effective in avoiding postpartum hysterectomy after conservative medical and surgical measures have failed. Although randomized studies are lacking, rhFVIIa should be considered as a second-line therapeutic option of life-threatening postpartal bleeding, in particular if preservation of fertility is warranted and hysterectomy is to be avoided.
©2012 by Walter de Gruyter Berlin Boston
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Articles in the same Issue
- Review article
- WAPM Working Group on Nutrition: Potential chronobiotic role of human milk in sleep regulation
- Opinion Paper
- “Every case of asphyxia can be used as a learning example”. Conclusions from an analysis of substandard obstetrical care
- Original Articles – Obstetrics
- Hematologic profile of the fetus with systemic inflammatory response syndrome
- Optimized amniotic fluid analysis in patients suspected of intrauterine infection/inflammation
- Risk factors for preterm delivery with placenta previa
- Recombinant human factor VIIa prevents hysterectomy in severe postpartum hemorrhage: single center study
- Combination antiretroviral therapy with protease inhibitors in HIV-infected pregnancy
- Vitamin D status during normal pregnancy and postpartum. A longitudinal study in 141 Danish women
- The impact of the time interval between two successive deliveries in an obstetric unit in terms of the mode of each delivery and the rate of perinatal mortality
- Original Articles – Fetus
- Terbutaline: effects on the fetal heart at term
- Parallel maternal and fetal immune activation by bacterial toxins in vitro
- Original Articles – Newborn
- Prepregnancy body mass index, socioeconomic status, race/ethnicity and breastfeeding practices
- Fetal and neonatal outcome in patients with anterior abdominal wall defects (gastroschisis and omphalocele)
- Total serum bilirubin level in umbilical cord blood and respiratory distress syndrome in very low birth weight infants
- Short Communication
- Improved overall delivery documentation following implementation of a standardized shoulder dystocia delivery form
- Letters to the Editor
- Prevention of prematurity – a complex undertaking
- Prevention of prematurity – a complex undertaking reply
- Congress calendar
- 10.1515/JPM-2011-1000
