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

摘要

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].