TITLE:
Approach to Massive Bleeding in Obstetrics: Changing Management Paradigms Oriented by Early Goals [Early Goal Therapy in Postpartum Hemorrhage]
AUTHORS:
Sandra Ximena Olaya-Garay, Juan David Hernandez, David Ricardo Murillo-Garcia, Manuel Andrés Garay-Fernández
KEYWORDS:
Bleeding, Coagulopathy, Postpartum, Fibrinogen
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.4,
April
22,
2021
ABSTRACT: Recent
findings: Approximately 830 women die every day worldwide as a result of
complications related to pregnancy or childbirth with obstetric hemorrhage that
remains a major cause of maternal morbidity and mortality. A systematic
analysis by the World Health Organization [WHO] on the global causes of
maternal deaths from 2003 to 2009 found that bleeding was the leading direct
cause of maternal mortality followed by hypertensive disorders and sepsis.
Overall, bleeding accounted for 27.1% of all maternal deaths worldwide. The
need to implement strategies that mitigate the impact of bleeding in this clinical
scenario is increasingly growing. Purpose of review: The purpose of this review
is to propose a management strategy based on goals established through dynamic
coagulation assessment. Summary: Effective management of obstetric hemorrhage
requires rapid recognition, rapid response and mobilization of the
multidisciplinary team. Volumetric resuscitation, hemodynamic stability, as
well as the simultaneous identification and treatment of the source of bleeding
and the resolution of coagulopathy in the shortest possible time remain the
cornerstones of the management of Postpartum Hemorrhage (PPH).